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I <br /> CANONIE ENVIRONMENTARCHAIN-OF-CUSTODY RECORD QAB PhOJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME la`T ��+i� �, c-rArji:ibJ V*2- SAMPLERS SAMPLE CONTAINER SAMkE DESCRIPTION CODES TAT CODES <br /> �/ (PRIN DESCRIPTION CODES A Ground Water F Oil <br /> o—k�_ �'Q (� �n n o_ / A 40-ml VOA Vial B Surface Water G Waste 1 Standard <br /> PROJECT NUMBER=5 "1 <br /> {SIGN} B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Pia:d'500-ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SodfSedirnent 4 Other <br /> } NUMBER OF ANALYSIS REdUESTED LABORATORY USE ONLY <br /> e CONTAINERS <br /> S AND 8 <br /> n PRESEAI+ATION $M m = r <br /> w� r S8 ;€ R x� SAMPLE <br /> s� TIZ-1 <br /> wo NOTES ASSIGNED CONDITION <br /> E° LLu � VBOTTLE UPONrDATE TIME SAMPLE ID = NUMBERS RECEIPT NOTES <br /> } <br /> 3 <br /> (Ps <br /> S - ' <br /> F <br /> J <br /> { <br /> NOTES/MISCE { NEOUS Relinquished by (Signature) R c I y Ig ure Date Time <br /> L AB S Ov0/A j g <br /> } inq he gna_� roe (Signature) Dat Time <br /> eiinquts By (Signature) Received By (Signature) Date Time ,>r <br /> i y <br /> Method of 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 �( p <br /> Chain (by Serial No) b <br /> (t I <br /> Send Lab Results to (Name) (Check Office Below) als Requested Yes ❑ No ❑s_ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER D OTHER 41Q hiqLST_a <br /> TEL(404)951-0055 TEL (303) 790-1747 TEL(714) 7571755 TEL(415) 960.1640 TEL(219)926-8651 TEL <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX(714) 757.0960 FAX(415) 960-0739 FAX(219)926-7169 FAX Z-0 .-.cam 57ZZ <br /> Q BOZCMASS ❑ 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(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 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> i SERIAL NO 1 ^ 7 n r WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W2 <br />