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CANONIE ENVIRONMENTALRHAIN-OF-CUSTODY RECORD *AB PROSECT <br /> (See Reverse for Instructions) NO • <br /> PROJECT NAME ,-fk0C,l<IWG SAMPLERS Af.-X_Tj&&dS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (�C �{ (PRI Q DESCRIPTION CODES A Ground Water F Ott <br /> PROJECT NUMBER �t+] - 14-7 _ ____ _ J'L f,�J�j ��}?_E/l/ A 40-m1 VOA Vial B Surface Water G Waste 5 Standard <br /> (SIGN} B Glass Liter E Brew Tube C Leachate H StankfSpike 2 46 Hour <br /> RECORDER C Plastic 500-m1 F other D Rlnaeale I Other 3 24 Hour <br /> (SIGN) D Plastk:Liter E SoIVSedlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> g— PRESERVATION _ R <br /> 1 �� SAMPLE <br /> ;7 a NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID § BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> r Mw-2 A ✓ I <br /> 115 air Mw-3 A ✓ <br /> I Ob I r ✓ <br /> I <br /> I <br /> NOTES I MISCELLANEOUS Relinquished by (Signature) Date Time <br /> LAB AL(,00 lkt%IL-i5 )-PvBS ' Relinquished By (Signature) Received 8 ignature) Date Time <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 /> Chain(by Serial No) <br /> AS2Iot1N �0RIk� Q.o Ot.EQ- I y (I 7-tl <br /> Send Lab Results to (Name) _ Jago 1-+4jje (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER 15 t-01"J <br /> TEL(214) 7701800 TEL(303)7901747 TEL(714) 7571755 TEL (415)960-1640 TEL(219)926-8651 TELUI t3 .3567 <br /> FAX(214)770-0249 FAX(303)799 0186 FAX(714)757-0960 FAX (415)960 0739 FAX(219) 926 7169 FAX Sb <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406)586 9496 TEL(713)589 8686 TEL(215)337-2551 TEL(510) 463-9117 TEL(503) 2410282 TEL <br /> FAX (406)586 9724 FAX (713)531-8886 FAX (215)337-0560 FAX(510)463 2981 FAX(503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 a TELEPHONE (214) 770-1800 • FAX(214) 770 0249 <br /> SERIAL NO r� /( WHITE Fleid Copy YELLOW Project Copy PINK Laboratory Copy REV 11193 <br />