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-----GANANIE—ENVIRONMENTAL— CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) (1352 nysE R_3 5--L NO. F?l/z3o <br /> PROJECT NAME �(�,:�� e .� YrF ��� SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P11 DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 114`7 X I . dQ0 1 -: , �. -- A. 40-m1 VOA Vial B. Surface Water G. Waste 1. Standard T <br /> ( IG ) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. r , \1 <br /> RECORDER�T0—1 L + K ,� <br /> (SIGN) C. Plastic 500-m1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> D. Plastic Liter E. Soil/Sediment 4. Other -e`ca�S <br /> NUMBER OF ANALYSIS 6EQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> _p oAND m <br /> m PRESERVATIOm^ A�- _Na N <br /> 8$ m8 LL (� S$ ;E¢ ��=t SAMPLE <br /> m`'ao NOTES ASSIGNED CONDITION <br /> — O <br /> e— _ p ) M E > BOTTLE UPON <br /> DATE TIME SAMPLE ID <br /> m N F- LL N z NUMBERS RECEIPT NOTES <br /> V.4 11 1ly-YJ4 I <br /> _ 7 L0 - QA <br /> ,_ ✓ ( SA <br /> WL ✓ t 4A-f_ Va 5- PYcs <br /> t► s� - 5. E ✓ (A <br /> '. <br /> i3 ✓ A <br /> ,r <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) 19�=;jved By: (Si nPure) D to Time <br /> i Pug 1197t.X by yA Vials..aa� ss6�a w --~ c Q_�G�` oh_4 <br /> (� a in d By: (Signal re) eceived By: (Signatu Date Time <br /> Clkyg= .,A, , `. �� RC����Lv�fS �y �LP/� FS?—� (] LGQ'9 �! ��- <br /> ReGnquishe y: (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 /y / <br /> C ro L E, fZ Chain (by Serial No.) <br /> 1 yZZI�+ 14 b°t (�f <br /> Send Lab Results to (Name): All - 1Ic (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW El PORTER <br /> V--/ <br /> OTHER <br /> TEL(404) 951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL Zti�l I �1 ZZZ <br /> FAX(404)956-9364 FAX(303)799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX _ — S <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 80111 • TELEPHONE (303) 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO. WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8/92 <br /> 140 � t: <br />