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CANONIE ENVIRONMENTALTHAIN-OF-CUSTODY RECORD &B PROJECT <br /> n .r., L��e�e Rgyprse for Instructions) NO <br /> PROJECT NAME" `+ SAMPLERSjff. 5`tira4rA SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> L- - on-31> 3- i FW4TY � DESCRIPTION CODES A Groundwater F oil <br /> PROJECT NUMBER oLe,� C A 4Qin1 VOA Vial B Surface water G waste t Standard <br /> (Sift 3 B (class Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER c Plastic 501)-ml F Ottrer 0 Rinasate I Other 3 24 Hour <br /> (SIGN) O Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> P <br /> $ <br /> AND Y • <br /> PRESERVATION <br /> , $ Fi SAMPLE <br /> d r� NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID Ji g <br /> NUMBERS RECEIPT NOTES <br /> ti ll i a <br /> _73-1-5 IFF-TI-7q Tr It ru <br /> ,TJ 71FIr 1 + <br /> c5.1 T97 !f S-r I U try <br /> ` I1 - 1t <br /> v S ! _ I <br /> u tIr 111S <br /> -411T1 u til <br /> -7---- <br /> U) <br /> -Ui sF 3p a i a tom + <br /> z C, I III V <br /> I )9T ! 1p - a { <br /> NOTES I MISCELLANEOUS GReli utshe��(Sigature) etved By ign__ A) 1 ) 11DTirZlt� <br /> Relinquls d By (Signature) Received By (Signature) ll Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-0f-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 /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER LJ OTHE� <br /> TEL(214) 7701800 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926 8651 TEL <br /> FAX(214) 770-0249 FAX(303) 799 0186 FAX(714)757-0960 FAX(415) 960-0739 FAX(219) 926-7169 FAX `' ` <br /> r <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) 2410282 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 • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770-1800 is FAX(214) 770-0249 <br /> SERIAL NO pi `1 q n WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy REV 1lw <br />