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r1 I ENVIRONMENTAL.;:,�'HAIN-OF—CUSTODY RECORD `� �UY�Y'�t�-A� raAOJFCrt <br /> ' (See Reverse�L';r Instructions) ^_3 5 <br /> �ROJECT NAME SAMPLERS At r 9 Ti-00 el- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES - <br /> (PRINT) DESCRIPTION CODES A. Ground Water F. Oil �: TAT CODES <br /> PROJECT NUMBERr . <br /> A. 40-mi VOA Vlal B. Surface Water G. Waste `l. Standard ' ' - <br /> ' (SIGN) B. Glase War E. Braes Tube C. Leachate - °t H. Blank/Splke - 2' 48 Hour <br /> .RECORDER C Plastic SMrni F.Othei D. Rlnsents :-I. Other 3' 24 Rour" <br /> (SIGN) D. Plastic Liter E. SolASedlmenl 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND r <br /> PRESERVATION <br /> IJ 04 Jg: , SAMPLE <br /> DATE TIME y Q F� —S NOTES ASSIGNED COUPON N <br /> SAMPLE ID O Z NUMBERS RECEIPT NOTES <br /> IF D <br /> i 7- <br /> -————————————— — I— _§ <br /> ------------ <br /> NOTES l MISCELLANEOUS N4CG,t 1 <br /> a �014uLAVA i`k% 50 LOY �S Ah� Relinquished by: (Signature) He elved By: (Signature) Date Time <br /> P P 6 ("r We%- � easy VM4 tiA¢. Rellnqu ed By: (Sign lure Re ved By: (Signature) Date O The <br /> 4Fw �piQS of C YCOrva 01TOLwas WjC.hr <br /> }° �tx�dL.►� AM's <br /> Ished By: Ig lure) IReceived By: (Signature) Date Time <br /> Gow -7 !tet z(;!b g1/7/q7 <br /> Meth of ipmen" Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab y: (Signature) bele Time <br /> �+ Transport Container Transported with this <br /> SITE(� Chain (by Serial No.) <br /> ?_ 09 rz <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ,❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER fY�Q QST[] <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) 7E9-0188 FAX (714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 F 5 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (416)586-9496 TEL (713) 556-1668, 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 90111 • TELEPHONE 303 290-6336 • FAX 303 290-8013 <br /> :ERIAL NQ 14717 <br /> WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV M2 <br />