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CANONIE ENVIRONMENTALWHAIN-OF-CUSTODY RECORD !4B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME rya-1:dam EA19� SAMPLERS M1' "rte SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES , <br /> 9q_ 3 z� 003 DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER A 40-m1 VOA Vial B Sudace 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 SWm1 F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> o S— PRESERVATION <br /> I _ SAMPLE <br /> a; NOTES ASSIGNED CONDITION <br /> _ BOTTLE UPON <br /> DATE TIME SAMPLE ID I z NUMBERS J RECEIPT NOTES <br /> l4m:r 6 S - E E <br /> r JonE E i r '*V 36 k,0 I <br /> s )Orr - ' E tr emer <br /> ) it poo GP - Lf - EE 16 <br /> G F 1s - E E f Y <br /> r11 OS' &P <br /> 111 t GP - - l ' E F Y re <br /> t 18 6-P Ile 1 - 9 ' I ` 6 E i <br /> aa-) s ! Crp S ) - I to i, <br /> r //),X 1r <br /> V <br /> �S <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) a eived By Wignaje) te Time <br /> r"got WMA, V/1111� <br /> Retinqu hed 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 Tlme Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes El �Nop _❑ <br /> ❑ DALLAS ❑ DENVER ❑ 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?-Q�- FIT, :I r%3 <br /> FAX (214) 770-0249 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415) 960-0739 FAX(219)926-7169 FAX a4A- 43 r- 3s fill <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)589 8686 TEL(215)337-2551 TEL(510)463-9117 TEL(503) 241-0282 TEL <br /> FAX (406) 586-9724 FAX(713)531-8886 FAX (215)337 0560 FAX(510)463-2981 FAX(503) 241-0486 FAX <br /> € CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 • TELEPHONE (214) 770-1800 a FAX(214) 770 0249 <br /> SERIAL NO ? i ^ n q WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 11193 <br />