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I <br /> CANONIE ENVIRONMENTAL *AIN-OF-CUSTODY RECORD *:i1iiIlOJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME )I'I r r SAMPLERS I- V -7-1 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT)--- DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER I L of- I U �` { A 40 rnl 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 500 ml F Other�_ O Rinseale I Other 3 24 Hour <br /> D Plastic Liter F Sod/Sediment 4 Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> }� CONTAINERS IL <br /> AND .f m $ a m <br /> n m ag PRESERVATION <br /> y8 a W a g$ yY` SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> i DATE TIME SAMPLE ID _ ' z NUMBERS RECEIPT NOTES <br /> f r <br /> I �llfll� c <br /> ALLLL) f"ik l <br /> l <br /> t <br /> ! 1 <br /> R I <br /> I` <br /> 1 <br /> NOTES!MISCELLANEOUS Relinquished Py (Signature) t RecJetved By (Signature\)/ I / Date Time <br /> Time <br /> l� 1 f/5t-_0 <br /> i 1 Relin ulshed By (Signature) Received By (Signature) Date Time <br /> R nquishad��%gnature) Re 4 Vi Byt ( e� l6el- 09me S <br /> Mdtho of Shipment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Received for lab By ItSlgnature) 1 Date time <br /> I Transport Container Transported with this <br /> Chain (by Serial No) <br /> l W <br /> Send Lab Results to (Name) � C �' ��� �r r't`''ti` � (Check Office Below) Verbals Requested Yes Na ❑ <br /> r <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ❑',OTHER <br /> TEL(404)951-0055 TEL(303) 7901747 TEL (714)7571755 TEL(415) 960-1640 TEL(219)926-8651 TEL209- 57 <br /> FAX (404) 956 9364 FAX(303) 799 0186 FAX (714) 757 0960 FAX(415)960 0739 FAX(219)926 7169 FAXR=" FT r <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-80`13 <br /> SERIAL NO t j� WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W92 <br />