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t. <br /> CANONIE ENVIRONMENTAL *AIN-OF-CUSTODY RECORD 'PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 1ALFMINOWS_ 2)C-_LIC, SAMPLERS AL,6 C Ldl'GL 5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ` t (�P�AINT}�—- DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 94-373 <br /> cit-t o A" �1F A 40-ml VOA Vial a Surface Water G Waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 4B Hour <br /> RECORDER C Pfashc 500 ml F Other D Rinseate f Other 3 24 Hour <br /> (SIGN) D Ptasuc Lrter E SoillSedimeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND ' <br /> a <br /> ^ m PRESERVATION $ mm <br /> r3 g$ LL 8=_� SAMPLE <br /> ao NOTES ASSIGNED CONDITION <br /> 2 E >� BOTTLE UPON <br /> DATE TIME SAMPLE ID Aqz NUMBERS RECEIPT NOTES <br /> NMI AD-40 M vJ 13 A3 1� d ✓ <br /> FEI <br /> NOTES 1 MISCELLANEOUS Relinquisher-_.e <br /> Siign�at�ure�)� Ref, wad By (Signature) Date Time <br /> �el quashed By (Signa re) Re the By (Slgnatur Date Time <br /> y 14 ) 4 s <br /> Relinquished By (Signature) Red ived By (Signature) Date Time <br /> G, L L C.E to)Cc) z54 <br /> Method of Shipment Descnption of Other Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> (L 0 � <br /> Send Lab Results t0 (Name) JEALItJ C 40{IAS (Check Office Below) Verbals Requested Yes Na ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER THER MA� TD <br /> TEL(404) 9510055 TEL (303)790 1747 TEL (714)757 1755 TEL(415) 960-1640 TEL(219)926 8651 TELZM_ —579—Z2,?Z/ <br /> FAX (404) 956 9364 FAX (303)799-0186 FAX (714) 757-0960 FAX(415) 960-0739 FAX (219)926 7169 FAXIMi <br /> BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586-9496 TEL(713) 55&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 NO WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />