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r r r r r r c c r c r2 ;c /yc - r <br /> CANONIE ENVIRONMENTAL U'AIN-OF-CUSTODY RECORD ---.e PROJECT <br /> f (See Reverse for Instructions) NO. <br /> PROJECT NAME 0 UVB I SAMPLERS �' )�u" "' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER — 1 �� rJ,� a A. 40-ml VOA vial a. surface water G. waste t,Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. BlanklSplke 2. 48 Hour <br /> 1 <br /> RECORDER '1 r .t�.` J"vfC. Plastic 500-m1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> �- <br /> (SIGN) D. Plastic Liter E. SCMISediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> PRESERASAMPLE <br /> TtON <br /> 3 s b <br /> a� $�TrBOTTLE <br /> aNOTES ASSIGNED COND TON <br /> .� <br /> DATE TIME SAMPLE IDm y g N UM RECEIPT NOTES <br /> t <br /> r <br /> NOTES 1 MISCELLANEOUS lhlinquished by: <br /> Signature) Received By: (Signature) Date Time <br /> l vorp cc), FP f f V <br /> ' 1 L 1IC1 Relinquished By: (Signature) Received By: (Signature) Date Time <br /> f �( ? Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of ShipmentDescription 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): _' l r S CjA (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ❑ OTHER <br /> TEL(214) 770-1800 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL <br /> FAX (214) 770-0249 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) 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 9 FAX (214) 770-0249 <br />