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lb CANONIE ENVIRONMENTAL 4PAIN-OF-CUSTODY RECORD 0 PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME I4%EM A t4 . '1_ C46 SAMPLERS AL EX T�ti eZ S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ry �� <br /> PROJECT NUMBER 01/ <br /> O JRINA� �� DESCRIPTION CODES A Ground Water F CHI✓� ►"` A 4t}ml VOA Vial B Surface Water G Waste 1 Standard <br /> ISIGhq B Glass Liter E Brass Tube C t,eachale H SlanklSpike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rinseale I Other 3 24 Hour <br /> IS1GN) D Plastic Liter E SrallSedrment �_ 4 Other — <br /> NUMBER OF _ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND �- <br /> �-�- PRESERVATION $Y �• � <br /> itisW cc� SAMPLE <br /> OR <br /> q <br /> 6 NOTES ASSIGNED CONDITION rt >DATE TIME SAMPLE ID �— a Z NUMBERS RECBOTTLE EIPT NOTES <br /> 300 -I AlRaq.1 V ✓ <br /> NON 6 310 <br /> LZ V- <br /> oA — — -— - -- --- <br /> 9 I - e <br /> 0946 MoK mvi-6 <br /> NOTES!MISCELLANEOUS V Relln utshed by Signature) Received By Signal re) Date Time <br /> .�B: (fir ort E sE 'RECbVD sgmQr,{t= Ahw o,,, <br /> y P\J R_AAUTU <br /> a4--7 upo 0 Relinquished By (Signature) Received By (Signature) Date Time <br /> A�2,R.� l01 l.. <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> � <br /> � Chain (by Serial No) <br /> Q <br /> "� <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER MO-r&$TZ <br /> TEL(404)951-0055 TEL(303)790 1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926 6651 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) 566-9496 TEL(713)5561666 TEL(215)337-2551 TEL(510)463 9117 TEL(503) 2410282 TEL PLO <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 /> I&PIAL NO C- �� WHITE Field Copy YELLOW Project Copy PINK Laboralory Copy REV tlra7 <br />