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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> f (See Rekztoverse for Instructions) NO. <br /> PROJECT NAME ' r I SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P N DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER A. 40-ml VOA Vial a. Surface water G. waste 1. Standard <br /> (SIGN) 8. Glass LOer E. Brass Tube C. Leachate H. BlanklSpiks 2, 48 Hour <br /> RECORDER c. Plas,lc Soo-rnl F.Other D. Rinseato I. Other 1 24 Hour <br /> (SIGN) D. Plastic Liter E. SoillSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> m AND e <br /> s ng PRESERVATION m 8m b <br /> a8 mLL m 1, of=� SAMPLE <br /> a= a m °z m y ,am ' m"< NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE IQ E- LL A BOTTLE UPON <br /> N = NUMBERS-I RECEIPT NOTES <br /> �( Y57 y i` <br /> 3 X <br /> a <br /> NOTES l MISCELLANEOUS f Relinqu e by:� ignature) e' By: ig J t Time <br /> Sri �v 3 fit. itaVIA 1 uw �� ? <br /> 7' <br /> unshed By:JSignature) eceived By: (SignatUe) Date TimeF.- <br /> D. 31c 5-7� Reling6ished By: (Signature) Received By: (Signature} Date Time <br /> 0 <br /> ethod of Shipmentescription of Other Chains-Of-Custody Dispatched By: (Signature) 1 Da Time Received for lab re) Date Time <br /> Transport Container Transported with this <br /> . J Chain(by Serial No.) <br /> Send Lab Results to (Name): (Check Office Below) V rbals Requested: Yes ❑ No ❑" <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)9266-7169 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)79x1747 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 /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL.(209) 983-1340 • FAX (209) 983-0304 <br /> SERIAL NO. 07067 <br /> J067 WHITE:Field-Copy YELLOW:Project Copy PINK:Laboratory Copy <br />