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CANONIE ENVIRONMENTAL L. ,AIN-OF-CUSTODY RECORD t PROJ;t'_CT <br /> (S51),Reverse for Instructions) NO. <br /> f KS y <br /> PROJECT NAME U�' O» 1-��If�'` SAMPLERS A_ _ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Q 01RrT) DESCRIPTION CODES A Ground Wale, F Oil / \ <br /> PROJECT NUMBER Ir1� f 1—S� A 40-ml VOA Vial B Surface Water G Waste 1 Standa,d <br /> (SIGN) B Glass Lila, E Brass Tube C. Leachale H Blank/Sp.ke 2 48 Hour <br /> C. Plastic 500 ml F Other _.. D Rmseale' I Other 3 24 Hour <br /> RECORDER D Plastic Liter _ E Sud/Sediment 4 Other <br /> (SIGN) <br /> NUMBER OF NALYSIS REQUESTED LABORATORY USE ONLY - <br /> CONTAINERS 4t a <br /> 4 AND <br /> g- s- PRESERVATION $ 8 p a <br /> qSria : SAMPLE <br /> a a _ "'o NOTES ASSIGNED CONDITION <br /> i E 0 BOTTLE UPON <br /> DATE— T1MF--- SAMPIF_ID -NUMB13E LC1 TPT NOTES <br /> Qkk 4- <br /> �9- 1 vC ,.. of a E 0 0 - <br /> r <br /> 9 :iA C r ,., r(!l� �rJ ► 1C5 73E. i 63o s— <br /> pr- <br /> NOTES/MISCELLANEOUS n had Igna ) Received By: (Signature) Date Time <br /> elinquish By. (Signature) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched y: (Signature) Date Time Received for lab By: (Signature) D e Time <br /> C.o Transport Cont in Transported with this /� <br /> Chain (by Serial No.) Q <br /> -1 <br /> I <br /> l Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No 1-1 <br /> I - <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL(219)926-8651 TEL(415)573-8012 TEL(714) 757-1755 TEL (407) 856-7428 TEL <br /> FAX(219)926-7169 FAX (415)573-5654 FAX(714) 757-0960 FAX (407) 855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT. VIEW OTHER <br /> TEL (303) 790-1747 TEL (215) 337-2551 TEL(713) 556-1666 TEL (415) 960-1640 TEL <br /> FAX (303) 799-0186 FAX (215) 337-0560 FAX (713) 556-0666 FAX (415) 960-0739 FAX <br /> I - - <br /> CANONIE ENVIRONMENTAL LABORATORY - 212 FRANK WEST CIRCLE, SUITE A - STOCKTON, CA 95206 - TEL.(209) 983-1340 - FAX (z09) 983-0304 <br /> SERIAL NO 03028 WHITE Field Copy YELLOW.Protect Copy PINK.Laboratory Copy <br />