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0 ! <br /> CANONIE ENVIRONMENTAL 9AIN-OF-CUSTODY RECORD *B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME Y0 �"c_rly SAMPLERS s SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ,�� y'(PRI DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER �tto A 40-ml VOA Viat B Surface Water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanktSpike 2 46 Hour <br /> RECORDER C Plastic SMmi F Other D Rfnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Luer E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND ^ s +_ <br /> `aa am PRESERVATION 8 m$ $ <br /> ;Ea SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> v 2 2 a °Y BOTTLE UPON <br /> DATE TIME SAMPLE IDV D 0 = NUMBERS RECEIPT NOTES <br /> 50 <br /> bCl �k <br /> 1l 0 <br /> Z <br /> +FFF <br /> NOTES 1 MISCELLANEOUS t �5� KaD" Relinquished by (51gnalure) Re eIK ed By (Signa#u e) Date Time <br /> -rr.Ws9-A 0" 0?00 Lg <br /> ,M R Lr ' Relinquished By (Signature) Received By (Signature) Date Time <br /> ^ %ATgm- %VA La, ey lk IA Relinquished By (Signature) Received By (Signature) Date Time <br /> N�� . <br /> oShipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Cbva,k e 9� Cobh psix <br /> Send Lab Results to (Name) 8 (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER S <br /> TEL(404)951-0055 TEL (303)790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TEL �/ <br /> FAX (404) 956.9364 FAX (303)799-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX <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)241-0282 TEL <br /> FAX(406) 586-9724 FAX (713) 556-0666 FAX(215) 337-0560 FAX(510) 463 2981 FAX(503)241-0486 FAX <br /> CArNONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO 14503 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />