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CANONIE ENVIRONMENTAL t.tIAIN-OF-CUSTODY RECORD `--iB PROJECT <br /> (See Reverse for Instructions) NO. l— <br /> PROJECT NAME (;WF-9. �R!]PECEr _ _-- SAMPLERS A46,6X 1ZQar:S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> O`�Q� (PRINr�r ✓ DESCRIPTION CODES A. Ground water F. oil <br /> PROJECT NUMBER i A. 40-ml VOA Vial B. Surface water G. waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> C- Plastic 5013-ml F.Other . Rinseate I. Other 3. 24 Hour <br /> RECORDER (SIGN) D. Plastic Liter G, E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> = AND r • v c a <br /> - m— - --. <br /> .a— m PRESERVATION <br /> 8 �Us .4 � � SAMPLE <br /> a- � cv NOTES- -ASSIGNED CONDITION- <br /> E� a s '� E °- BOTTLE UPON <br /> DATE TIME SAMPLE ID N 0. z NUMBERS RECEIPT NOTES <br /> wq] 131 Vs V �• j <br /> lZibq 111 MW- 3 i s <br /> lZ H ILIO A L11 :5 ✓01 11 <br /> !c� <br /> 0 <br /> E <br /> per-�v} <br /> ori w <br /> [n r <br /> i <br /> NOTES 1 MISCELLANEOUS �� , Relinquished by: (Signature) Received By: (Signature) Date Time <br /> i.4xS3ll .``ZE�kI�►�irI1T{c.1'�(... <br /> a,5 ppb BN-". p� Relinquished By: (Signature) Received By:-(Signature Time <br /> V'1-,e,`4 kdQ_ capi�c..S q <br /> Wim r, 4Qq�,,,,�� lingkuished By: (Signature) Received By: (Signature) Date Time <br /> JY7T d �r Fern <br /> Method of Shipment Description Of Other hains-Of-Custody Dispatched By: ( ignature) IDate Time Rece' d for lab By:lSignB re) Date Time <br /> Transport Container Transported with this / <br /> Chain (by Serial No.) ( _ <br /> PA <br /> Send Lab Results to (Name): Af'I-S (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHERW-5 <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TE <br /> FAX (404)956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX (219)926-7169 FA5^ <br /> P ❑ 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 />�I 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 /> L 1(� <br /> SERIAL NO. �I /t 6 19 <br /> WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV."2 <br />