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i <br /> CANONIE ENVIRONMENTALOHAIN-OF-CUSTODY RECORD &B PROJECT <br /> (see Reverse for Instructions) NO <br /> PROJECT NAME ti• r+ SAMPLERS�NA" -vL"*A SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> a= <br /> NT DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 91- 3 0 01 f 0 A 40amt VOA Vial a Surface water G waste t Standard <br /> (SIGN) B ss GlaLiter E Brass Tube C Leachate H Blank/Splke 2 48 Hour <br /> RECORDER C Plastic 500-m1 F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) 0 Plastic Liter E SoillSedirnent 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS Y <br /> AND r <br /> PRESERVATION <br /> E S i SAMPLE <br /> lilt <br /> it J _ F - NOTES ASSIGNED CONDITION <br /> 0 BOTTLE UPON <br /> DATE TIME SAMPLE ID Z. NUMBERS RECEIPT NOTES <br /> Ir s . A p <br /> s mwA 3 i <br /> 4:FF-, -It--T <br /> NOTES!MISCELLANEOUS elm tushed by Signature) Rec tved By gnaturai ate Time <br /> Rel•ngwshe By (Signature) Received By (Signature) a e Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transporl Container Transported with this <br /> Chain(by Serial No) <br /> 09141j- <br /> Send <br /> 9r99.fSend Lab Results to (Name) a ati-, (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ElDENVER t❑ IRVINE ❑ MT VIEW ❑ PORTER ly OTHER <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL U4-F3g3sD <br /> FAX (404)956-9364 FAX(303)799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX 'o IJUE-ase? <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)556-1666 TEL(215)337-2551 TEL(510)463-9117 TEL(503) 241-0262 TEL <br /> FAX(406)586.9724 FAX(713) 556.0666 FAX(215)337-0560 FAX(510)463-2981 FAX(503)241-0486 FAX <br />;I CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8/92 j <br />