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�� �. I"�- C`� ['-'� r„`'� <br /> CANONIE ENVIRONMENTAL. ,iA1N-OF CUSTODY RECORD ���-B—F�'ROm <br /> (See Reverse for Instructions) <br /> PROJECT NAME V� r 1 SAMPLERS ' r «'r' 4 +r��^ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES ` <br /> PRIr�T]I DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER S - l r r�i �(� A. 40-m1 VOA Vial B. surface water G. waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. BlanklSplke 2. 48 Hour <br /> RECORDER U `l �j�srLf,} C. Plastic 500-m1 F.Other D, Ainseate I. Other 3. 24 Hour <br /> {SIGN) D. Plastic Lilar E. SoillSediment 4. Other <br /> NUMBER OF; ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND I u? ° <br /> g--am PRESERVATION I � �m m <br /> Ig SA m-. <br /> c� am N8�_� SAMPLE <br /> am NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE IDmv LL V ~` - NUMBERS RECEIPT NOTES <br /> r U <br /> z� 9� <br /> Z)-3 " 6- 1 ! a <br /> NOTES I MISCELLANEOUS rL /3 C2 C, & (�f � inquished by: ignature) Receiv¢d By: (Signatureyj Date Time <br /> r�' � ,L <br /> �- �� t�c45� �'�' CWyG('Q'lrf dS 4 /7�1�� � Relinquished By: (Signature) I <br /> Received By: (Signature) Dae Time <br /> " UTA L GSI r f'�v feG1 : Pli.�s�fatc.5 , <br /> 7-F- M�Q f� dli-eCt<Gdl /00-se ceya �'A'a" /)tc 1'i l we Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Tr o l,�(�IJ� OA c7A 92-60 C04 rpvv <br /> Meth d 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 /> Send Lab Results to (Name): ► tti ,�l'�'�rtScAr, (Check Office Below) Verbals Requested: Yes No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER Ef/OTh)EA <br /> TEL(214) 770-1800 TEL(303)790-1747 TEL(714) 757-1755 TEL(415) 960 1fi40 TEL(219)926.8651 Tj �f1 J5- <br /> -0249 <br /> S / <br /> FAX (214) 770 0249 FAX (303) 799-Oi86 FAX (714) 757-0960 FAX (415)960 0739 FAX (219) 926-7169 FA 571 Z <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) 241-0282 TEL <br /> FAX (406)586.9724 FAX(713)531-8886 FAX (215)337-0560 FAX (510) 463-2981 FAX (503)241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770-1800 • FAX(214) 770-0249 <br /> SERIAL NO. n�- n ® WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV. 11!93 <br /> L G <br />