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CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD OAB PROJECT <br /> _ (See Reverse for Instructions) NO <br /> PROJECT NAME s7-X, SAMPLERS�i1c� :�rtt7lfl�f qt E?' t ((.�*'e `' <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT)f `� 1'" r DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER �� 3�� a✓Q_ /i �� "�U '` `� A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank)Splke 2 48 Hour <br /> RECORDER _ _ -- _ _ _ _ _ C Plastic 500 ml F Other D Rinseale I Other 3 24 Hour <br /> (SIGN) O Plastic Liter E Soll/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS -I � <br /> AND <br /> PRESERVATION 9 �� g '4 <br /> SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID Wv z NUMBERS RECEIPT NOTES <br /> o-7064q Doi) t.1 I t ' <br /> i F <br /> Y)N% -Mv V ] I V A 17-1 <br /> ` _ J r , V c <br /> i <br /> NOTES I MIS LLANEOUS -einquishyd�y (Sigre) R�pivaq try (Signature) 1 ! D t T{rrte 7 <br /> Relinquished By (Signature) Received By (Signature) Date Time <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 /> �� Transport Container TrChainsported wit! this <br /> ) <br /> Send Lab Results to (Name) k Of 1'��'!. (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER L{ OTHER f�UDF;rf) <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)7571755 TEL(415)960-1640 TEL(219)926-8651 TEL- ref <br /> FAX(404)956-9364 FAX (303)799-0186 FAX (714)757 0960 FAX (415)960-0739 FAX(219)826-7169 FAX �� 4��•` <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 (406)586-9724 FAX(713) 556-0666 FAX(215) 337 0560 FAX(510) 463 2981 FAX(503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES CORP • 6100 1;0tITH SYRAr l I4F WAY 4I IITF Rnn . Ftif;l F1h100n f`f 1 Antli . TPI 1=QunrlG onm nnn ovac . CAV ion'31 nnn anio <br />