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e Ppojt,,CANONIE ENVIRONMENTALVHAIN-OF-CUSTODY RECORD ► <br /> (See Reverse Air Instructions) N(k <br /> PROJECT NAME ��I[tAf,et? TR-OyE"T SAMPLERS AL 9A SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIN DESCRIPTION CODES A. Ground water F 411 <br /> PROJECT NUMBER 94-37-(- 'A A 44m1 VOA Vial B Surlace water G waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanldSplks 2 48Hour <br /> RECORDER C Plastic SMml F Other D Rlnseste I Other 3 24 Hour <br /> (SIGH) 0 Plastic Liter E Soll/Sediment �r!%V 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS y 1' <br /> AND <br /> — PRESERVATION <br /> gra SAMPLE <br /> �. NOTES ASSIGNED CONDITION <br /> _ rV BOTTLE UPON <br /> DATETIME SAMPLE ID # ACy NUMBERS RECEIPT NOTES <br /> 3 / I Det <br /> S 1440 4P ✓ <br /> p .4 Ar 1 ✓ r <br /> 03 LO MV4-5 A A, 3 ✓ l ✓ <br /> oCDP M w h V.31 V ✓ I ✓ <br /> 1610 I I& ✓ t <br /> NOTES!MISCELLANEOUS Refin uEsh by (SEgnature) Recalved By (Signature) tate Time <br /> Relinquished By (Signature) ecelved By [ gnature) Datdme <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 Serial No) <br /> Aorj CAOLef, <br /> Send Lab Results to (Name) 10A___LA)116-R-+,&A►J (Check Office Befow) Verbals Requested Yes ❑ No ❑ <br /> El DALLAS El DENVER El IRVINE El MT VIEW ❑ PORTER L✓i l7THER <br /> TEL(214) 770-1800 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926 8651 TEL?-OR 131r- 5q7 <br /> FAX(214) 770-0249 FAX(303) 799.0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAXZ0qj <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586 9498 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 a TELEPHONE (214) 770-1800 a FAX(214) 770_-0249 <br /> SERIAL NQ 10 <br /> Q S WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 11193 <br />