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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME lU r ! `� t ` SAMPLERS — �"°��_ ut�rlr4e: SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBERt A. 4G-mi VOA Vial B. Surface Water G. Waste 1. Standard <br /> {SIGN)' B. Glass Liter E. Brass Tube C. Leachate H... Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic 504-mt F Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF I ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION f( ? m 3 m H <br /> Ug o$ m LLm g® ; SAMPLE <br /> ji <br /> NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE 9D � �- LL rn Fm s F > I BOTTLE UPON <br /> y NUMBERS RECEIPT NOTES <br /> Lh�+!7 I - tr &3cr< <br /> Lx,. <br /> NOTES 1 MISCELLANEOUS I in�quis ed b (Signature) By: { n re) Da Time <br /> 3 a U-- r I ,tet 7 Relinquished By: (Signature) Received B (Signature) Date Time <br /> v 4 g ) y { g } <br /> C7 <br /> �7 3 Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Metho ZTP-M <br /> ent Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab a Date Time <br /> T ansport Container Transported with this <br /> 411 <br /> Ch b Ial No.} / I / <br /> Send Lab Results to (Name): rT (Check Office Below) Verals quested: Yes ❑ No ❑ <br /> ❑ PORTER ❑ SAN MATEO ❑ IRVINE ❑ ORLANDO ❑ OTHER <br /> TEL (219) 926-8651 TEL (415) 573-8012 TEL (714) 757-1755 TEL (407) 856-7428 TEL <br /> FAX(219)926-7169 FAX (415) 573-5654 FAX (714) 757-0960 FAX (407) 855-2595 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT. VIEW ❑ OTHER <br /> TEL (303) 790-1747 TEL (215) 337.2551 TEL (713) 556-1666 TEL(415) 960-1640 TEL <br /> FAX(303) 799-0186 FAX (215) 337-0560 FAX (713) 556-0666 FAX (415)960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY e 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL.(209) 983-1340 • FAX (209) 983-0304 <br /> SERIAL NO. 07069 WHITE:Field Copy YELLOW,Project Copy PINK.Laboratory Copy <br />