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ATC'_ w ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> A <br /> (See <br /> � Reverse for Instructions) <br /> PROJECT NAME GlAaNWE p. 1w1 QVr V__ q SAMPLERSALFX 7 Lioa'eS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Qv,�.'7J Pool <br /> DESCRIPTION CODES A. GrouiW Water F. oil <br /> PROJECT NUMBER"69.• Pool fig T-('KJ�Ci ! -�( .1Y-�J-� A. 40 ml VOA Vial B. Surlace Water G. Wesle 1. StanAerd <br /> (SIGN) S. Glass Liter E. Brass Tube C. Leachate H. elankfSplke 2. 48 Hour <br /> RECORDER ), C. Plastk 500-m1 F.Other D. Rinseate 1. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Solt/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND Y_ <br /> €-n- PRESERVATION �- Ql- S C a _ <br /> 8 a SAMPLE <br /> t! $_ <br /> d NOTES ASSIGNED CONDITION <br /> E- - € - BOTTLE UPON <br /> DATE TIME SAMPLE ID '� _ y NUMBERS RECEIPT NOTES <br /> t - I / <br /> �' � - - IZ•5 1 <br /> _ r 1 <br /> aq <br /> OSA• ` - 1 C <br /> NOTES I MISCELLANEOUS Relinquished by: (Signature) RISC 'Wed By: re) ate Time <br /> it u <br /> Relinquished By: (Signature) Received By: Slgnaur lu 'Date TI <br /> Relinquished By: (Signature) Received By: (Signature) pate Time <br /> Method of hipmant Dills6ription of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this / ,r <br /> -�� Chain (by Serial No.) // <br /> /y/, <br /> -e ta(:t t 114125 A /{ <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER 5 <br /> TEL (404) 951-0055 TEL(303) 790-1747 TEL (714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL 2 <br /> FAX (404) 956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX - - •7 Z <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) 241-0406 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> •FnIAI NO 1 , .. `^I u.r rinl.l flrnry •-11" 1 PINKI,r —` ... nnr n n� <br />