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CANONIE ENVIRONMENTAL &AIN-OF-CUSTODY RECORD 013 PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME f ill 14 �J� 1( — SAMPLERSSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES + <br /> 3-7 3 01 7 Q -A (PAIN DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER A 40 ml VOA Vial B Surlace Water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tuba G Laachale H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other —� D Rlnseate I Other 3 24 Hour <br /> (SIGN) D PlesOc Liter E SoNSedimenl —_—__— 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS U <br /> AND <br /> �a— — PRESERVATION y� Y— " <br /> $ , = W �a € SAMPLE <br /> YYNOTES ASSIGNED CONDITION <br /> o 6 rI <br /> � <br /> 3f <br /> X. BOTTLE UPON <br /> lDAATQE TIME SAMPLE ID - I— $ NUMBERS RECEIPT NOTES <br /> Q 310 _ -Z.. 1a tL 3 — - ✓ - — — - f -tL-- vC it <br /> Mmk.137-0 W- ✓ _ _ _ <br /> ---- --------- - <br /> NOTES!MISCELLANEOUS Relinulshod by (Signature) Received By (Signal re) Date Time <br /> n ,E S E Rsc p+I�D <br /> LA V`14 Pt,� DAkwa <br /> `l P6R_0.TU R-E V Pn 1T Relinquished By (Signature) Received By (Signature) Date Time <br /> Aw2�v <br /> AL,. <br /> r_R�9_hnquished 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) Dale Time <br /> Transport Container Transported with this <br /> �DD Chain(by Serial No) <br /> �p <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER MOINIST D <br /> TEL(404) 9510055 TEL(303) 790-1747 TEL(714) 7571755 TEL(415)960-1640 TEL(219)926 8651 TEL �_ Z. <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 TEI (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 t303) 290 8336 0 FAX (303) 290-6013 <br />