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.. � LAB PRdJECT, <br /> CANONIE ENVIRONMENTAL.CHAIN-OF-CUSTODY RECORD I.I. <br /> (See Reverse fcw,f tWucUon9) NO, r. a <br /> PROJECT NAME RDWA �._.� SAMPLERS CALAA SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES k <br /> DESCRIPTION.CODES A. around water F.ON <br /> PROJECT NUMBER 0 JL 4$0VOA vlat IL Sunagewabr 3 watttt 1. standard <br /> B Gast UW E.ftli Tuba C. Leach6 N.MWWsplta 2.46 Hour <br /> RECORDER ` G Pl:sfic 5006{ F.00W is D. Rineeati L 0t1W a 24 Hour . <br /> t Q Ptasdt:Lrtar E s6medimatil 4.Other <br /> NUMBER OF eANALYSISREQUESTED LABORATORY USE ONLY <br /> CONTAINERS y <br /> AND 1 11 <br /> ti <br /> - PRESERYIQION g <br /> S ? ; SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE 10 NUMBERS RECEIPT NOTES <br /> W G <br /> E � •� .r , <br /> rc� <br /> � uQSFQ <br /> r <br /> o s <br /> •l � 2 <br /> NOTES!MISCELLANEOUS et' quis a ei y: ( ig ure at Time <br /> SktC. 5tez'l Mus Thi,, �r�(•n l}+fi�.l: BNa �attrz+� <br /> rD 13 -5)'0'uJ Qd. �+ 5+ee4 P1.5 ZZc, <br /> �ttxlc+oh 1�.iJ, avF BraD� elinq fished By: (Signature) eceived B .(Si attire) Date Time <br /> 5+oc,t+Ca" ,CA.'}15 <br /> Relinquished By:(Signature) Received By:(Signature) Date Time <br /> Met od of Shipment Desuiption ofOther Chains-Of Custody Dispatched By-,(Signature) Date Time Received for lab By: (Signature) Dae Time <br /> Transport Container Transported with this r <br /> Chain(b„Serial Na.) <br /> [� <br /> Send Lab Results to (Name): &Wa Pai±gm 1z 4CLOW11 U , 5 (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑. OTHER <br /> TEL(219)926-Ml TEL(415)573-8012 TEL(114)757-1755 TEL(407)556.7428 TEL <br /> FAX(219)926-7169 FAX(415)5735654 FAX(114)757-0960 FAX(407)855-2595 FAX <br /> ❑ OENVER ❑ KING OF PRUSSIA ❑ HOUSTCW I ❑ MT. VIEW ❑ OTHER <br /> TEL(303)790-1747 TEL(215)337-2551- TEL(713)550-1666 TEL(415)950-1640 TEL <br /> FAX(303)799-0166 FAX(215)337-0560 FAX(113)5564)668 FAX(415)9600739 FAX <br /> cm.'O":E t'NV, 0Nal...ENE AL I A€30i ,099Y • 2;2 FRANX I'*LE-".'2T CIRCLE, ."it::Tc A • STOCKTON. CA 55206 • TEL. 209' 963-1340 • FAX ''%Aa83-03C4 <br /> SERML No. WHITE:A64d C-My YELLOW,PA Cc" PIM Uwatory Copy <br />