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CANONIE ENVIRONMENTAL HAIN-OF-CUSTODY RECORD 9131 PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 6*abNER- RZOO&eU SAMPLERS /411LOEIX�y71be.E4 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN+r^ DESCRIPTION CODES A Ground Water F Dd <br /> PROJECT NUMBER_ q'i -32.6 OY--/Q A 40-ml VOA Vial B Suriace Water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SmVSedlmeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> � 4 AND c < <br /> c 6m PRESERVATION $ 8m $ <br /> ;E � SAMPLE <br /> �� E <� NOTES ASSIGNED CONDITION <br /> a� 3e i iL �m a BOTTLE UPON <br /> DATE TIME SAMPLE IDv = NUMBERS RECEIPT NOTES <br /> D MW-2- ! <br /> al,711, 1100M W-3 A Al I ISI ✓ <br /> vun JL05NAW-If A A 1 111 ✓d <br /> I W716 115T MU01.WELL 31 1 11 ✓ <br /> NOTES/MISCELLANEOUS �^ Relingyisf*"y (Signature) R eived By (Signature) Date Time <br /> LA.B. ML6o tJ li�-- <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 Transported with this <br /> >7 AC)tj Chain (by Serial No) <br /> Li- <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER _OTHER <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL f <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX fZs <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) 241-0282 TEL <br /> FAX (406) 586.9724 FAX(713)5560666 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 303 290-8013 <br /> SERIAL NO 14620 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />