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r\ta!-, tA <br /> ENVIRONMENTAL AIN-OF-CUSTODY RECORD PROJECS) <br /> , r <br /> (See Reverse for Instructions) Q75 C, NO � ,zap9' <br /> PROJECT NAME Snr_�700 T!Qf 61tL2, SAMPLERS&EK TIO SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> } g_ <br /> (PRINT)— DESCRIPTION�, `" DESCRIPTION CODES A Ground Water F Oil 1 �f <br /> PROJECT NUMBER G 25714 C3 C]('] _ &(.[& bt�:[,y� A 40 ml VOA Vial a Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER ( J <br /> C Plastic 5Mml F Other 1) Rmseate I Other 3 24 Hour <br /> (SIGN) 1) Plastic Liter E SodfSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> 8 a <br /> AND <br /> �^m n PRESERVATION <br /> s`8 m mSAMPLE <br /> m 'mY <br /> aINOTES ASSIGNED CONDITION <br /> Em °V BOTTLE UPON <br /> Iw <br /> DATE TIME SAMPLE ID Nm = LU z NUMBERS RECEIPT NOTES <br /> 1 y <br /> r <br /> r. - <br /> ` r <br /> NOTES 1 MISCELLANE US - ` Relinquished by (Signature) a eiv By t n lure Date Time <br /> )LL. <br /> R Ilnqut ed B Slg atu e) Rec MPH By (signature) a eTlme <br /> elinquished By (Signature) Received By (Signature) Date Time <br /> NOOTIE <br /> Method of S Ipment Description o then lChains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this 7 �r <br /> Chain (by Serial Na) r– 1!A(9 � -� 1 J yys <br /> Send Lab Results to (Name) S – I (Check Office Below) Verbals Requested Yes ❑ No El <br /> 3ATLANTA ElDENVER L1IRVINE ❑ MT VIEW ❑ PORTER !-OTHER I <br /> TEL (404) 9510065 TEL (303) 790-1747 TEL(714) 7571755 TEL(415) 960-1640 TEL(219) 926-8651 TELZd zu <br /> FAX (404) 956 9364 FAX (303) 799-0186 FAX(714)757-0960 FAX (415) 969-0739 FAX(219)926 7169 FAX Z a <br /> U 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 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 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80i11 • TELEPHONE (303) 290-8336 • FAX (303) 290-80 33 <br /> SERIAL NO WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br /> 14745 ---- <br />