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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME OLI (J T,'-r M9 A1rE64 SAMPLERS '4LEV ru,T2os SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> n / _ n-(PRI'NN DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 95- 13 6 �'� 1C. A. 40.mI VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) -B. Glass Liter E. Brass Tube• C. Leachate H. Blankspike 2. 4B Hour <br /> C. Paslc w nrl F.Other D. Rinseate I. Other_ 3. 24 Hour <br /> (SIGN) <br /> RECORDER D. P:.:c Liter E. SoillSediment - 4. 011ier <br /> NUMBER OF NALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e g rl <br /> `o AND O 8_ _ S 1Q 00 I fFI Coll) <br /> _= u— PRESERVATION 2 p } <br /> 8 S$ € 4x d 4' Nm €€` !uSAMPLE <br /> _ 6_ o �; _ F ._o NOTES ABOTTLED UPON CONDITION <br /> DATE TIME SAMPLE ID NUMBERS RECEIPT NOTES <br /> 1 2 - D 1 1 1 Mo. <br /> 3 --5 D 1 V 1 <br /> NOTES I MISCELLANEOUS Rel ina &by: (Signature) Re ed By, at e) Dale Time <br /> Q �R(oRtr MEQ^ , <br /> 1N( W b,e riS16Q, CAI&ICUI Relinquished By: (Signature) e i re lul Im 16 <br /> �. �%j I i� ` eI , , linqu' y: (Signature) Received By: (Signature) Date Time <br /> Ill <br /> 61 d`4� <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatche By: (Signature) Date Time Re ived for lab By: (Signature) Date Time <br /> /�� Transport Container Transported with this <br /> Chain (by Serial No.) I () �{ .74 1 <br /> govuEa / S 57 �/" "I //� <br /> Send Lab Results to (Name): S G V (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA El DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER r t"eSI <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL �Z� <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAXZ�-Pr-Z5- <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 EMORIONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUME 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • F 03) 290-8013 <br /> SERIAL NaWHITE:FieldCopyYELL Copy PINK:Laboratory Copy REV&92 <br /> • , �nr <br />