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� � � r � � r r �■r r �r <br /> CANONIE ENVIRONMENTAL &AIN-OF-CUSTODY RECORDB PROJECT <br /> / (See Reverse for Instructions) ��NO <br /> PROJECT NAME SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> {P DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER r A 40-mi VOA Vial B Surface water G waste 1 Standard <br /> {SIGN) B Glass Liter E Brass Tube C Leachate H BlanidSplke 2 48 Hour <br /> RECORDER C Plastic 5D0-ml F Other D Rmseate I other 3 24 Hour <br /> (SIGN) D Plastic Liter E Soil/Sedlmeni 4 Other <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> : CONTAINERS <br /> cc AND r <br /> �—S^ PRESERVATION $— 1m $ <br /> m"ggSAMPLE <br /> z 8m € $�o NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID y = NUMBERS RECEIPT NOTES <br /> .� rki <br /> l �-- o <br /> SZ3r� <br /> 2 O <br /> 2 <br /> r <br /> MY <br /> YO <br /> NOTES 1 MISCELLANEOUS eiinqu hed by Signature) V;�-! Signature) Date Time <br /> t 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 Transported with this <br /> Chain (by Serial No) <br /> s <br /> Send Lab Results to (Name) T61,4 (Check Office Below) Verbals Requested Yes Pf No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER O—OTHER <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926.8651 TEL 'r <br /> FAX(404)956-9364 FAX(303) 799.0186 FAX(714)757-0960 FAX(415)960-0739 FAX (219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND I ❑ OTHER <br /> C TEL(406)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)556-06661 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) 290-6013 <br /> nrn1A1 r.in -- r w IAIHITF C-1,1 VFI!PAM PmI Orrin PIm 1-h—i— r— RFV AIQ9 <br />