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CANONIE ENVIRONMENTA HAIN-OF-CUSTODY RECORD A8 PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME LwrAvkq-( <br /> � t SAMPLERS s v^ �L''sS SAMPLE CONTAINER, SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Ground Weller F 04 <br /> PROJECT NUMBER ` ` - 3 >t';' Qb3 Y^, A. 40-m1 VOA Vial 8 Surface water G waste t Standard <br /> (130N) B Glass titer E Broas Tube C Leachate H 131anWplka 2 48 Hour <br /> RECORDER c Plastic BOG-ml F Olhsr D Rlnseals 1 other 3 24 Hour <br /> Islam D Plastic Liter E S(lASedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATIONSAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME <br /> SAMPLEIQ NUMBERS RECEIPT NOTES <br /> -1 C.n <br /> I <br /> NOTES/MISCELLANEOUS e n shed 4 Ignature) J F� Ceived By (Signature) Date Time <br /> qulshe By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Dale 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 Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHES �� Uh <br /> TEL(214)770-1800 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 /> ❑ SOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ arHER � <br /> TEL(406)586-9496 TEL(713)589-8688 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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 * DALLAS, TX 75240 * TELEPHONE (214) 7701800 * FAX(214) 770 0249 <br /> SERIAL NO 21 1 A 7 <br /> WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV W93 <br />