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i CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAMES70(rIC[OAJ Tt2E 5T-*T-JV j -*Z SAMPLERS 44EX 6016Z15-5 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> d I IN DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER -jLf -3(,-7 L0-(` (PR -~C�J�[.�1 A 40-mlVOA Vial B Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tuba C Leachate H Blank/Spoke 2 48 Hour <br /> RECORDER C Plastic 5MMI F Other D Rlnseate I other 3 24 Hour <br /> (SIGN) D Plastic Liter E SocllSedlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> 8 AND $1 <br /> ag — PRESERVATION $ � a <br /> I12 t 10 96' SAMPLE <br /> o v �� B NOTES ASSIGNED CONDITION <br /> F m11 �� r>T BOTTLE UPON <br /> DATE TIME SAMPLE ID V 1 a q 2 NUMBERS RECEIPT NOTES <br /> 01Z3 u-1— 8 3 ✓ <br /> 0 20 EAVJ-Z, 2 3 ✓ <br /> [ 47 1240 MVJ-3 B <br /> 01UR7 lZ00 IA W-4 At a 2 3 ✓ <br /> 6msi7 3 MW- A A Z <br /> f <br /> NOTES!MISCELLANEOUS ehnquis Z by (Signature) I y tg ture / Date Time 1 <br /> Relinquished By (Signature) meived EW (Signature) Diater Time <br /> I <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 /> I�lA1.f��LS , Transport Container Transported with this <br /> Chain (by Serial No) <br /> CA()It I 611 CAGE e 114 SO 157 <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER M0-h193rV <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960.1640 TEL(219)926-8651 TELZOI-579-ZZZ-1 <br /> FAX (404)956-9364 FAX(303) 799.0186 FAX(714) 757-0960 FAX(415)9600739 FAX(219)926-7169 FAX Z09-579-ZzZS <br /> ❑ 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) 2410282 TEL <br /> FAX(408) 586-9724 FAX(713)556-0666 FAX(215)337-0560 FAX(510)463-2981 FAX (503) 241-0486 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 14506 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8792 <br />