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CANONIE ENVIRONMENTAkWHAIN-OF-CUSTODY RECORD NAB PROJECT <br /> (See Reser or Instructions) <br /> PROJECT NAME G A t-fi e 1 e.OQ SAMPLERS ArLx '7t L oSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES s <br /> (PRINTI DESCRIPTION CODES A Ground Water F Oil <br /> NUMBER -34, . �� A 40-m1 VOA Vial B Surface water G Waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSptke 2 48 Hour <br /> RECORDER C Plastic 50"1 F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plasflc Liter E SoiVSedjmonl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> AND <br /> a— PRESERVATION Y <br /> 111 qil � <br /> ,1 SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> � °V BOTTLE UPON <br /> DATE TIME SAMPLE ID y 0 NUMBERS RECEIPT NOTES <br /> 3f3q <br /> OL9 RMW-Z R t/ t 14 D S <br /> IoOb tNVJ 3 A Al IVII ✓ <br /> 1010 �W l4 ► ✓ V <br /> I � <br /> NOTES I MISCELLANEOUS Relinquished (Signature Received By Signa re) Date Time <br /> 1iWeATLIXOf jr] Relinquished By (Signature) Received By (Signature) Date Time <br /> I Relinquished By (Signature) Received By (Signature) Date Time <br /> Q m fa 1lltl, % o <br /> Meth of Shipme t Descnp Ion 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) S$O <br /> Send Lab Results to (Name) :1 lmLt)f+,rxmaY� _— (Check Office Below) Verbals Requested Yes eNo ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER B'OTHERS 41k-''°°'�Jlj q <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926 8651 TEL 2 ,�+7 <br /> FAX(404)956.9364 FAX(303)79th-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX (219) 926-7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586-9496 TEL(713)556.1666 TEL(215) 337-2551 TEL(510)463-9117 TEL(503) 241-0282 TEL <br /> FAX(406) 586.9724 FAX(713)55$-0666 FAX (215)337-0560 FAX (510)463-2981 FAX(503)2410486 FAX <br /> CANONIE ENVIRONMENTAL SE=RVICES, CORP * 6300 SOUTH SYRACUSE WAY, SUITE 300 * ENGLEWOOO, CO B0111 * TELEPHONE (303) 290-8336 * FAX 303 290-8013 <br /> SERIAL NO 1 9 <br /> ^ Q I� WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />