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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. _2y/'0 <br /> 1 i l <br /> PROJECT NAME PL SAMPLERSSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> POINT) DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER C �, .1t� A a0-ml VOA vial B Surface wale, :3 waste 1 Standarn <br /> (SIGN) 8 Glass tiler E Brass Tube G Leachate H BlanklSpike 2 48 Hour <br /> C Plastic 500-ml F Other ❑ R,nseale I Other 3 24 Hour <br /> RECORDER_ --- — D Plastic Liter E So,llSed,menl 4 Olher <br /> (SIGN) N <br /> NUMBER OF t`ANALY IS REQUESTED _ LABORATORY_ USE ON_L_Y_ <br /> CONTAINERS k e � <br /> m AND <br /> PRESERVATION <br /> $ x 8 SAMPLE <br /> i- z $5 i- U a` � a �­ NOTES ASSIGNED CONDITION <br /> ?_ ii E BOTTLE UPON <br /> DATE TIME SAMPLE ID N NUMBERS ' RECEIPT NOTES <br /> - — — _ 11L ' <br /> FF -- — <br /> NOTES 1 MISCELLANEOUS / of qulsh�d ,.(fi" r�} a ei q y. ( ig ture� f ate Time <br /> �nt+¢.� / /� <br /> Iv13 Showa R _ elingL61rried By: (Signature) eceived By: (Sigtlature) D Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Met od oI 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 T' <br /> CChain (by Serial No.) � _� V /Q r� <br /> Send Lab Results to (Name): a«+tc� ;v-&) Kw11 D 0 Nr5 (Check Office Below) Verbals Requested: Yes ` . NO <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO OTHER <br /> TEL(219)926-8651 TEL (415) 573.8012 TEL(714) 757-1755 TEL(407) 856-7428 TEL _ <br /> FAX(219)926.7169 FAX (415) 573.5654 FAX(714) 757-0960 FAX (407) 855-2595 FAX_ <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT, VIEW OTHER <br /> TEL(303) 790-1747 TEL(215) 337-2551 TEL(713) 556-1666 TEL(415) 960-1640 TEL <br /> FAX(303)799-0186 FAX(215)337-0560 FAX(713) 556-0666 FAX (415)960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY - 212 FRANK WEST CIRCLE, SUITE A - STOCKTON, CA 95206 - TEL.(209) 983-1340 - FAX (209) 983-0304 <br /> SERIAL NO. UJ419 <br /> WHI It F mid Copy Yl l LOW Project Copy PINK I ahnratory Copy <br />