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t ,( I [ 4 Tr 4_t -t 't" 5 . t l - t t t t t t It t [ t [ <br /> � NIEENWRO1V1n EN I`AC CHAIN-OF-CUSTODY RECORD ' <br /> LAB PROJECT <br /> l (See Reverse for Instructions) C 352 RgSE R-3,5-z NO. <br /> PROJECT NAME VGSAMPLERS �^ (-�1 ``"r"` SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRIM DESCRIPTION CODES A. Ground water F. oil <br /> PROJECT NUMBER I4 ' c�C)U. -�_ <br /> -� A. 40-m1 VOA Vial B. Surface Water G. Waste <br /> (SIGN) B. Glass Liter E. Brass Tube - C. Leachate H. Blank/Spike 2. 48 Hour <br /> 1 L`�� �`�.�F=�'� C. Plastic 500-m1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> RECORDER <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other , r� <br /> NUMBER OF ANALYSIS FREQUESTED LABORATORY USE ONLY <br /> CONTAINERS q e <br /> o` AND -4 <br /> PRESERVATION $^ M A" <br /> S8 8 g i, m E ° SAMPLE <br /> o " r cc_ ao_ NOTES ASSIGNED CONDITION <br /> E- <br /> 2 E > BOTTLE UPON <br /> DATE TIME SAMPLE ID 4✓ V N =' NUNIBERS RECEIPT NOTES <br /> Ilt�l�1I.S%AN S - 5 — Z,o.66 ✓ I t t <br /> SI ti�-5+� 1 - Z �.0 ✓ 1 <br /> \= ✓ ✓ <br /> A L '' <br /> NS= S - 3v,U t E <br /> C6A-C <br /> NOTES/MISCELLANEOUS Rglinquished by: (Signature) Re ed By jg lure) D to Time <br /> Tk-AA j ,191L. I'7 £eq ric 15,.,,,A c;ZO � -��..., :- ..�� � vL�' / rf l�� , f t D I - C) i <br /> Reli <br /> tiy�- ..�1� (.,.t� :��� t..�• s Uy ze>� �sZL�--� Z red B (Signal re) Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method tit Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> Trans ort on Iner Transported with this r f.'��L �� Chain (by Serial No.) /f�, ���� ���/% f l Imo✓ <br /> c <br /> 00 I L\ r i l y'I Z b'>- 1 LA UC 'j <br /> Send Lab Results to (Name): ^""`- \ C.��tse y �4TL- l\loc\Fs v C (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT.VIEW ❑ PORTER OTHER <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL <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 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. 1 4r 31 f` WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8192 <br /> - (-, <br />