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Alt A3r--M.,�MNEWDE 1,L' � <br /> HVIR0NIV iAb," HAIN-OF-CUSTODY RECORD y AB PROJECT <br /> (SeeAiverse for instructions) NO. — C, <br /> PROJECT NAME STK a 5M IT R (At,.)A�- SAMPLERS ,4 <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES ` <br /> PROJECT NOMBER Z�] r;}���,. y+ +{I�k DESCRIPTION CODES A. Groundwater F. Oil <br /> A, 40-m1 VOA Vial B. Surface Water G. Waste 1. Standard _ <br /> - (SIGN) B, Glass Liter E. Brass Tube C. Leachate H. BlanklSpike 2. 48 Hour <br /> REORDER - - - - C. Plasbc 500-mi F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter EVoi115adiment 4- Other <br /> NUMBER OF ANALYSIS REQUESTED LAB <br /> CONTAINERS ORATORY USE ONLY _ <br /> 5 m AND <br /> �`mg PRESERVATION a a $ <br /> d a� 2 E E¢ _° SAMPLE <br /> a= -_ z �m m`—a� NOTES ASSIGNED CONDITION <br /> E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID y a N z NUMBERS RECEIPT NOTES, <br /> ty <br /> 001p <br /> K x JIS5 n2_ Lh 11 v t L <br /> v7 V <br /> t^ ✓ <br /> NOTES I MISCE LANEOUS 0 Relinquish e y. Signature) Received By: (Signatare) 9 to Times <br /> �• Relinquishe B : (Signature} eceived By: (Signature) Date Tlme. <br /> ( Relinquished By: (signature) Received By: (Signature) Date <br /> Method of.5hipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time; <br /> Tr'ansp'ort Container Transported with this <br /> Chain b Serial No � `r <br /> Q-110 Z: E ,,: too E-.9L. t ri <br /> Send L'ab Results to (Name):' N �' � - '� ` (Check Office Below) Verbals Requested: es ❑ N. L T; <br /> ❑ ATLANTA ElDENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER LJ OTHER Oa <br /> TEL(404)951.0055 TEL(303) 790-1747 TEL(714) 7571755 TEL (415) 960.1640 TEL(219) 926-8651 TELZ <br /> FAX(404) 956-9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415) 960-0739 FAX(219) 926-7169 FAX <br /> BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON El PORTLAND ED OTHER v <br /> k' 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 /> aCANONIE ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. IIF n ..WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.892 <br />