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14 <br /> I ENVIRONMENTAL ISAIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME �, .1FTC)�� SAMPLERS A BLF—x fix", SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> y(� (PRINT) � DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBERaC)C�1 Cj"t • –&—I('-` A 40.mlVOA Vial B Surface water G waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> C Plastic 500-ml F Other ❑ Rinseate I Other 3 24 Hour <br /> RECORDER p PlasLc Laer E SoII75edoment 4 Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS �Q <br /> m `o AND iV tl <br /> ±m ng PRESERVATION <br /> $8 2 t € & SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> 31 6° i n p-.. <br /> £ . = ti t BOTTLE UPON <br /> E 2 E <br /> DATE TIME SAMPLE ID y _ l� y = NUMBERS RECEIPT NOTES- <br /> -4a ' <br /> 1lZIo 7 <br /> 1 <br /> Lld <br /> vvw L'7- <br /> t t <br /> NOTES I MISCELLAN�EpUS Relinquished by (Signature) Received By n ture / Date Time <br /> Gr <br /> N I ease P [-� AQ, X 1� Nr4T 5 .0 r , <br /> I DEI 9 TE51 Relinquished By (Signature) Received By (Signature) Date Time <br /> I to 1 <br /> ri1 <br /> OW �S2_6iO ar4l-y. <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of 5 1pment Description of Other Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> y� Transport Container Transported with this <br /> f t Chain (by Serial No) <br /> f1 q_�/O_010 t1� l�_L j C) <br /> Send Lab Results to (Name) L �� � 1 (Check Office Below) Verbals Requested Yes L1No El <br /> ElATLANTA ❑ DENVER ElIRVINE ElMT VIEW ElPORTER OTHER <br /> TEL(404) 9510055 TEL(303) 7901747 TEL (714)7571755 TEL(415)9601640 TEL(219) 926-8651 TEL. - - �,Y, <br /> FAX(404)956-9364 FAX(303)799-0186 FAX (714) 757-0960 FAX(415) 960-0739 FAX(219)926-7169 FAX <br /> tQ BOZEMAN ❑ HOUSTON ElKING OF PRUSSIA ElPLEASANTON ElPORTLAND ElOTHER = 1 <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 <br /> FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013&] <br /> SERIAL NO � � � � � WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy <br />