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faROJcT <br /> CANONIE ENVIRONMENTAL SAIN-OF-CUSTODY RECORD a <br /> (See Reverse for Instructions) NO <br /> PLt y -I t ( ' r r'PROJECT NAME SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> I (PRINT)-� DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER—(- V t� C C7f 1 4 K "L, j- ' -� A 40 ml VOA Vial B Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Plastic 500mi F Other 0 Rinseate I Other 3 24 Hour <br /> (SIGN) 0 Plastic Liter E SodlSedi t 4 Other <br /> NUMBER Of ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS i <br /> = AND z �p <br /> rJ a s <br /> PRESERVATION <br /> g� a= LCI ` 9 S E SAMPLE <br /> pp m ` NOTES ASSIGNED CONDITION <br /> e E— a = LL r 2 E ? BOTTLE UPON <br /> DATE TIME SAMPLE ID ° y -' �- y = NUMBERS RECEIPT NOTES <br /> AV,I- (0 V <br /> k <br /> NOTES I MISCELLANEOUS R ` �'i ,y of , '!S� 5 Relinquls ed by (Slgnaturp R wed B 1 6ature) Date Time <br /> IAL. - F /15,T1 FSI ` �11 I }�'t rt.�� tIflsf,IL Liatr F, ,, <br /> AL. Ut:� „t <br /> , { Relinquished By (Signature) Received By (Signature) Date 'Time <br /> CV btu ��fa `6Z <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 /> Transport Container Transported with this <br /> )11 L Chain (by Serial No) <br /> 10 k CLIIE Iz C,00Le IL I q 7�- I <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER QlOTHER <br /> TEL (404) 9510055 TEL(303) 790-1747 TEL(714) 757-1755 TEL (415)9601640 TEL(219) 926 8651 TEL t <br /> FAX (404) 956-9364 FAX (303) 799-0186 FAX (714) 757 0960 FAX (415)960 0739 FAX (219) 926 7169 FAX i t 1-,I 1 ` <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER _ <br /> TEL(406)586 9496 TEL(713)5561666 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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 1303) 290-8336 • FAX (303) 290 8013 <br /> SERIAL NO 1 A 71 li WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W92 <br />