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CANONIE ENVIRONMENTALIPHAIN-OF-CUSTODY RECORD &B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME L a�r��k.e s' �« c� SAMPLERS `t' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> } 3 Z(_ Ot��..i O tP �l DESCRIPTION CODES A Ground water F oil ' <br /> PROJECT NUMBER .. `1 — _ _ �.r..� �w.xm� _7 <br /> A 4atnl VOA Vial B surface waist o waste 1 Standard <br /> (SIGN) B Glace Liter E Breus Tube C Leachate H Blank/Splke 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other D Rinaeate I Other 3 24 Hour <br /> (Slam 0 Plastic Lder E SoillSedlment 4 Other <br /> I <br /> NUMBER OF ANALYSIS <br /> CONTAINERS REQUESTED LABORATORY USE ONLY <br /> � <br /> AND 01 <br /> PRESERVATION i1 <br /> ¢ V H SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID z NUMBERS RECEIPT NOTES <br /> 3 .p- l <br /> vtr <br /> I IN <br /> 1 fr E <br /> tit E <br /> z� a'si — O.O` r <br /> oz I QCK aLiL - yu 4=- ' <br /> I <br /> I <br /> NOTES r MISCELLANEOUS Relinquished by (Signature) Received By Signa ure) at Time <br /> [J <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Desarlptlon of Other Chalns-0f-Custody Dispatched By (Signature) Date Time Received for tab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) )16,1." __ V, L�y`� - (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS bENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(214) 770-1800 , TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926.8651 TEL �o�t�S3Ss'3S-L? <br /> FAX(214) 770-0249 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926 7169 FAX �T3(,3 <br /> ElBOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER A <br /> TEL(406) 588 9496 TEL(713)589-8686 TEL(215)337-2551 TEL(510)4639117 TEL(503)2410282 TEL <br /> FAX (406) 586-9724 FAX(713)531-8886 FAX(215)337-0560 FAX(510)463 2981 FAX (503)2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 o TELEPHONE (214) 770-1B00 s FAX(2i4) 770 0249 <br /> SERIAL NO 211 /14 <br /> 11A /4 WHITE Field Copy YELLOW Prolecl Copy PINK Laboratory Copy HEV n19 i <br />