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CANONIE ENV IRON MENTA CHAIN-OF-CUSTODY REP Lae PROfCT <br /> ~� (See Reverse for Instructions) �(p NO. * - <br /> PROJECT NAMESTV=O :�Zr)c S=C)bt M*'7-- SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI DESCRIPTION CODES A Ground Water F Oit <br /> PROJECT NUMBERt —�I 7 h A 4o-ml VOA Vtal a Surface water G waste 1 Standard <br /> .'+��f��� (SIGN) B Glass Liler E Brass Tuba C Leachate H BlanldSpike 2 48 Hour <br /> C Plastic 500 ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN} <br /> RECORDER D Plastic Lller E Sail/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND ° °r <br /> a PRESERVATION 9 1 m # a $ <br /> $ <br /> g LL m S I? g =Y SAMPLE <br /> ma � .x4$ P "°TNOTES ASSIGNED CONDITIO <br /> N <br /> ReNm 4 E BOTTLE UPON <br /> DATE TIME SAMPLEID <br /> - <br /> A = NUMBERS RECEIPT NOTES <br /> I A- <br /> 10219 <br /> I <br /> NOTES l MISCELLANEOUS Relinquished by (Signature) Recemp y (Signature) Date Time <br /> s(1J1`t <br /> LPt�: ��Qt toPE�-e°Tu U011) ulS <br /> (Signature) N By (Signature) Date Tlme <br /> L-AB Am\\IA L , ( U_� <br /> inquished By (Signature) Rec ived By (Signature) Date The <br /> Ie <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Signature) Date Time Rec tt <br /> r lab By (Signature) Date Time <br /> Transport Container Transported with this y <br /> �� Chain (by Serial 1y o) <br /> 9 Z� 1 111 v <br /> Send Lab Results to (Name) EnAIAZE 4459J4 (Check Office Below) Verbals Requested Yes ❑ Nd❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404) 951-0055 TEL (303) 790-1747 T 714) 7571755 TEL(415) 960-1640 TEL(219)926 8651 <br /> FAX(404) 956-9364 FAX (303) 799-0186 FA04),757 0960 FAX (415) 960 0739 FAX (219)926-7169 >AX 4 <br /> ❑ f30ZEMAt1 ElHOUSTON ElKING OF��MSSIA ❑ PLEASANTON ElPORTLAND ElOTHER <br /> TEL(406)586 9496 TEL(713) 556-1666 TEL (2 ,3)r-2551 TEL(510)463-9117 TEL(503) 241 0282 TEL <br /> FAX(406) 586-9724 FAX (713) 556-0666 4"' 0560 �_ -FAX (510)463 2981 FAX (503)ft-X0486 FAX it <br /> CANQNIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE`304• ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br />