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MONS PROJECT <br /> ENVIRONMENTAL ,.�:j:��ii��:� -OF-CUSTODY RECORD <br /> '�LAAIN <br /> (See Reverse for Instructions) NO. <br /> .:>'T v,T p rJ iN X, :F 1 TION CODES <br /> PROJECT NAME SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION TAT CODES <br /> 6,2G-ili. rcD-,7 (17"T'. DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER A. 40-ml VOA Vial B. Surface.Water 0 waste 1. Standard <br /> (SIGN) B_ Glass LTIer E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic 500-ni1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoillSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> A9PRESERVATION z 8 a & <br /> GPM SAMPLE <br /> 6 NOTES ASSIGNED CONDITION <br /> m <br /> ES z 2 > BOTTLE UPON <br /> P E o <br /> DATE TIME SAMPLE ID z NUMBERS RECEIPT NOTES <br /> 04039-� lo 1 1114 0 1. <br /> TC UT-7 <br /> V <br /> NOTES I MISCELLANEOUS Relinquished by: (Signature) R99eived By: S' natur ) Date Time <br /> 3. /S/D,-1 <br /> Relinquished By: (Signature) Received By: (Sjdnature) Date Time <br /> E—Relnquished By: (Signature) Received By: (Signature) Date 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 /> V_Ic I?- <br /> Send Lab Results to (Name): JCC\VI)C_ W !'E-"l (Check Office Below) Verbals Requested: Yes ❑ No <br /> ❑ ATLANTA D DENVER El IRVINE El MT VIEW ❑ PORTER elOTHER A4 0 de-s/6 <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 /> 0 BOZEMAN El HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON 0 PORTLAND El 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) 566-9724 FAX(713) 556-0666 FAX (215) 337-0560 FAX(510) 463-2981 FAX (503) 241-0466 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 a ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL.NO. 515 91 WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory copy REV.W92 <br />