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CANONIE ENVIRONMENTAL COIN-OF-CUSTODY RECORD ROJECT <br /> r� (See Reverse for Instructions) NO <br /> SAMPLERS N-�, *F10 <br /> PROJECT NAME (� LD1S�R. { ���"T-� 2-11 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES � <br /> DESCFUPTION CODES A Groundwabr F 08 <br /> PROJECT NUMBER_ A4 32.0 _. — -A A 40-d VOA Vlar B surfam wa v G wome r smadard <br /> (SIGr4 8 preaa Lbw E BranTtbe C lsaabate H. Bianwoii s 2 46 Hwr <br /> RECORDER C P:,Ld1 SOdml F Omer D Rums$-$ L Olr,er 14�' 0 24 xwr <br /> (SIGNS D PI1a1br Litat E Soll18erlirnero t Qrhar <br /> NUMBER OF ANALYSIS REQUESTED _ _LASMATORY USE ONLY <br /> CONTAINERS t <br /> a AND <br /> e PRESERVATIONSAMPLE <br /> $ <br /> t1 Air <br /> Y NOTES ASSIGNED CONDITION <br /> x s• a . BOTTLE UPON <br /> DATE TIME SAMPLE ID s NUMBERS RECEIPT NOTES <br /> / 1.4 A <br /> o po ✓ <br /> ,y r 3P 00, <br /> I ✓ v <br /> 0 3 ZD w- 3-21M1 ✓ ✓ <br /> G toA I IV 3 V ✓ <br /> Sb IPollI <br /> WNOTESLLANEOUS Relinsulshhed by (Signature) Received By (Signature) Date Time <br /> ha: fro- <br /> C .' <br /> ,AorJ Relinquished By (Signature) ecelved By gnature) es Ime <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 /> �A`_ Chain(by Serial No) <br /> A iiori �A O Le?, <br /> Send Lab Results to (Name) ._aM L4Irh-16!1&A tJ __... (Check Office Below) Verbais Reque�s�teed Yes Cl_,N1_ <br /> a� _ _ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW J PORTER tJ OTHER ' SCALO `'J <br /> TEL(214)770-1800 TEL(303) 79D-1747 TEL(714)7571755 TEL (415)960.1640 TEL (219)925-8651 TELZbs yar-35-0 <br /> FAX(214)770.4249 FAX(303)799-0186 FAX(714)737-09W FAX(415)960.0739 FAX(249)926-7169 FAX 7,OqO <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA G PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(446)586-9496 TEL(713)5696686 TEL(215) 337-2551 TEL(510)4639117 TEL(503)241-0282 TEL <br /> FAX(406) 5569724 FAX(713)5318886 FAX (215) 337-05W FAX(510) 463.2961 FAX (503)241.0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1600 a DALLAS, TX 75240 a TELEPHONE 214770-1900 a FAX 214 770.0249 <br /> SERIAL NOWHITE Flad Copy YELLOW Praeer Copp P[NK Laborowy CM REV '1185 <br /> 21085 - -- - - - W <br />