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C C �' 1 C C C C C C C `" C t C C r / j 61r_ 11c C <br /> CANONIE ENVIRONMENTAL LrIAIN-OF-CUSTODY RECORD LAB PROJECT <br /> _ (See Reverse for Instructions) NO. <br /> PROJECT NAME 111111((JJ P SAMPLERS t SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. Oil <br /> _..:. l ' <br /> PROJECT NUMBER__ 7 / _ .tis 1-f� A. 40-ml VOA Vial B. .$I1rlaCe water G, waste I. Standard <br /> (SIGN) B. Glass Liter E Brass Tube C. Leachele H. BlanklSpike 2. 48 Hour _ <br /> RECORDER / `'�" � +J" � C. Plastic 500-m1 F.Other J ��LO- D. Rinseaie I. Other 3. 24 Hour <br /> {SIGN) - D. Plastic Liter _ E. Soil/Sediment 4, Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND g <br /> I,,' <br /> c� PRESERVATIONll�a QI 3 m <br /> r <br /> �� a E $ <� NOTES ASSIGNED SAMPLECOND TION <br /> E" e— s = ;:U ��. ry E o— BOTTLE UPON <br /> DATE TIME SAMPLE ID 1� ° <br /> t- { L Z NUMBERS RECEIPT NOTES <br /> G re-i <br /> NOTES I MISCELLANEOUS Aeli 'quished b' : (Signature) Received By: (Signature) Date Time <br /> r <br /> } 1f��(' Relinquished By: (Signature) Receive B + <br /> y: ( nature) Date Time <br /> Relinqu d B ignature) Re eived : (Signa e) aE 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 /> Send Lab Resuits to (Name): (Check Office Below) er a s 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 /> ❑ SOZEMAN ❑ 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 />