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0CANONIE ENVIRONMENTAN&HAIN-OF-CUSTODY RECORD #BPROJECT <br /> (See Reverse or Instructions) <br /> PROJECT NAME s d'^ SAMPLERS. LININ•!w J CA" SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES r <br /> PRINT) DESCRIPTION CODES A Ground Water F 011 <br /> PROJECT NUMBER��'3 fat'/U TA--k 1 S A 4am1 VOA Vial 8 Surlace Water a Waste Standard <br /> (SIGN)j B Glass Liter E Brass Tube C Leachate H Blank/Spike r <br /> RECORDER C Plastic 500-ml F Other D Rlnseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E Soti/Sediment 4 Mer <br /> I NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> AND ice ^ <br /> ^ <br /> PRE <br /> SERVlCTIDN <br /> r$ <br /> �� SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> I BOTTLE UPON <br /> DATE TIME SAMPLE ID JYv NUMBERS RECEIPT NOTES <br /> ti �-�la Iq 4:S s IAd A,*I-' ? - 1 1 11 <br /> 2 iso -T - 8 Y <br /> 3 oki,5 8 A <br /> q of 3,-°l 3J r S 0 3. ANW - A 0 A 3 71 I <br /> NOTES l MISCELLANEOUS Relinquished b (Signature) Received By Signature) D Time <br /> ` �3 .� <br /> Rete qui r d By (S nature) R ed By (Stgnature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chalns-Of-Custody Dispatched By (Signature) Time Received f r lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> I A �l f <br /> Send Lab Results to (Name) ° a""� (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER 19 OTHER ''-` <br /> TEL(404)951.0055 TEL(303)790.1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926.8651 TEL g`�S'd� <br /> FAX(404)956-9364 FAX(303)799-0f88 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926.7169 FAX.ate r-3 S pe <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> SEL(44%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) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303 290-8336 a FAX 303 290-8013 <br /> SERIAL NQ WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />