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CANONIE ENVIRONMENTA HAIN-OF-CUSTODY RECORD AB PROJECT <br /> (See Reverse or Instructions) N9 <br /> PROJECT NAME r�al9��1�1C2 � At.t�X <br /> SAMPLERS F-t.v g"�S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER l N- 3z(�% (PRINT] <br /> DESCRIPTION CODES A Ground water F Oil <br /> A 40-mil VOAA Vial Vial B Surlace water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Plastic 50arn1 F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoNSed:menl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> — $^ PRESERVATION SAMPLE <br /> 8 X <br /> $ " <br /> r d ? ANOTES ASSIGNED CONDITION <br /> $TV BOTTLE UPON <br /> DATE TIME SAMPLE ID '` NUMBERS RECEIPT NOTES <br /> zggT Ilbo MW A I I V 140AY5 ✓ ✓ <br /> 2J95 t23o MW 2 A A ✓ 3 1 ✓ <br /> 09245 MW 3 A I V 13 K ✓ <br /> oq2qq5 1 p A I v ✓ ✓ <br /> 1?2g9s 11"zo fow_5 A V 3 7I ✓ <br /> 00Iz9q5* 1210 M W-b A IV, t ✓ <br /> 4 <br /> 5 <br /> NOTES!MISCELLANEOUS elinquis ignature) j R c Ived By ( gnatur ) Date Tim <br /> PLE1+,5E /io T� ���P� � 00A� ; )t <br /> LArs FMFe-- Art�R� v <br />� ,1 PO N Relinquished By (Signature) Received By (Signature) Date Time <br /> huh tA0%IL LAMS, A22./r/,4Z . <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 Senal No) <br /> 6�`R O <br /> /SSS <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑' ATLANTA ❑ DENVER ❑ IRVINE ❑ M7 VIEW ff PORTER OTHER E r cAkod D7 <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714)757-1755 TEL(415)960.1640 TEL(219)926-8651 TEL <br /> FAX(404)956-9364 FAX(303)79MI86 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX d g <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(�13)556.1888 TEL (215)337 2551 TEL(510)463-9117 TEL(503)241-0282 TEL <br /> FAX(406)58('x9724 FAX(713)'556-0686 FAX(215)337-0560 FAX(510)463-2981 FAX(503)2410486 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 r C WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W2 <br />