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CANONIE ENVIRONMENTALOAIN-OF-CUSTODY RECORD &B PROJECT <br /> (See Reverse for Instructions) NO. _ <br /> PROJECT NAME OLS N S. ����rE SAMPLERS 14G9V03 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 5- 136 <br /> �I /�_(PRI-NT) 1 As— DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER�t]e 13 6 1�1 lrl tz -7�( J A. 40.m1 VOA Vial B. sanece 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 500-ml F.Other D. Rinseate 1. Other_ 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS a <br /> AND 9 2— _ — <br /> 's Sm PRESERVATION $ v a$ <br /> $ it' S" E€g $y 86- SAMPLE <br /> 8P d o a �= $ .- NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID v o NUMBERS RECEIPT NOTES <br /> D AllI I I ( o <br /> k A. I1 I ✓ ✓" <br /> 35 -5 A 111 1 1 1 IV I ✓ d <br /> NOTES MISCELLANEOUS ?g"91 Relinq by: (Signature) Rec ed By" gnatu e) Date Time <br /> Ro' v M60t Relinquished By: (Signature) a ived By: ( ure) Date Time <br /> IIspi Ci2�Cd,Crt G,,, / <br /> At, I bt�tr -1i ` J 0/ Relinquished By: (Signature) R ceived By: (Signature) Date Time <br /> - <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 /> },i'l1t (91 A- Chain (by SerialNo.) <br /> fJ I S 573 <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑l <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER 25010THER A,4bel V <br /> TEL(404)951-0055 TEL(303)790-1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 <br /> FAX(404) 956-9364 FAX(303)799-0186 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) 556-0666 FAX(215) 337-0560 FAX(510) 463-2981 FAX (503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 60111 • TELEPHONE (303) 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO. 15584 <br /> CCO /1 WHITE:Field Copy YELLOW:Prolect Copy PINK:Laboratory Copy REV.892 <br />