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z <br /> PROJECT <br /> CANONIE ENVIRONMENTAL GAIN-OF-CUSTODY RECORD & <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME I 1IF4 .461 w t t t �)�:T��!1� SAMPLERS AuEEx SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 (P I}— DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER — ) Q„ �L�Q_. HiQ_ A 4D ml VOA Vial H Surface water G waste 1 Standard <br /> {SIGN) B Glass Luer E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rrnseate 1 Other 3 24 How <br /> (SIGN) D Plastic Liter E SomSedimant 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS a <br /> S AND <br /> u8 PRESERVATION <br /> mY $=n <br /> m e s SAMPLE <br /> "q5 NOTES ASSIGNED CONDITION <br /> E� E°7iw <br /> BOTTLE UPON <br /> DATE TIME SAMPLE kD �' � z NUMBERS RECEIPT NOTES <br /> F <br /> r � <br /> iz <br /> 37 A <br /> 42AD ; W14- <br /> 1 <br /> NOTES I MISCELLANEOUS /RelinqulsheM(S19nature) R calved By (Signature) Date Time <br /> LAB. tJ Relinquished By (Signature) Received By Signaufe) Date 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 /> �N Transport Container Transported with this <br /> O <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requestedr,Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER S 7 <br /> TEL(404)9510055 TEL(303) 7901747 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) 2410282 TEL <br /> FAX (406) 586-9724 FAX(713)556-0666 FAX(215)337 0560 FAX (510) 463-2981 FAX (503)2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NOp ^ WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV &92 <br />