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F <br /> 10 CANONIE ENVIRONMENTAL GAIN-OF-CUSTODY RECORD 10,PROJECT <br /> ( (See Reverse for Instructions) NO <br /> PROJECT NAME 1 1A 1 t~AAwM I'S `�3E"t C E' SAMPLERS A"L;EX �a,,Es SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 9L4-373 <br /> '1_.�7 01- 10 <br /> I� J (Pa RINiI . DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER L4 3 1 �C9 -�G- / A 40 ml VOA Vial H Surface Water G Waste i Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanIdSpike 2 46 Hour <br /> RECORDER C Plastic 500-ml F Other 0 mnseaie I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS ❑ <br /> c AND c 'a <br /> c ng PRESERVATION m a v a 0x w— <br /> mm m x1 S g m <br /> 38 ink e Ix 0�_ SAMPLE <br /> m2 ao NOTES ASSIGNED CONDITION <br /> Em a a = �- E °- BOTTLE UPON <br /> DATE TIME SAMPLE ID 41 z NUMBERS RECEIPT NOTES <br /> (WOM 1035 I <br /> 00111 A A ✓ <br /> i <br /> NOTES!MISCELLANEOUS Relinquished by (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Spment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> D, y Transport Container Transported with this <br /> rel Chain (by Serial No) <br /> Send Lab Results to (Name) —k-ANAtE IVLS E (Check Office Below) Verbals Requested Yes ❑ No 0 <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER WOTHER 6157'0 <br /> TEL(404) 9510055 TEL(303) 790 1747 TEL(714) 757 1755 TEL(415)960 1640 TEL (219) 926 8651 TEL2 ±:4!79-ZZZ/ <br /> FAX(404) 956 9364 FAX (303)799 0186 FAX (714) 757 0960 FAX(415) 960-0739 FAX (219) 926 7169 FAX U?--579-2ZZ5 <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) 241-0486 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 NO 1 A WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />