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� 'tititi\ <br /> ``.. <br /> C ANOMIE ENVIRONMEIRAIN-.OF-CUSTODY RECORD <br /> ., (See Reverse for Instructions) No <br /> PROJECTNAhiIEAu'�R4 �� SFt+-fN �r-+t�`E SAMPLERS xL()k� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CORES r' <br /> t -7 t" /"� (PRIN DESCRIPTION CODES A. Ground Water F. Oit r' r <br /> PROJECT NUMBE'�i � V '� !� h�" A. 40-ml VOA Vial <br /> B.-Surface Water G. Waste 1. Standard <br /> - (SIGN) B. Glass Liter E, Brass Tube C. Leachate - H. BlankJSpike 2. 48 Hour <br /> RECORDER C.rPlastic 600-ml F.Other D. Rinseate L Other <br /> S. 24 Hour <br /> (SIGN) - D. Plastic Liter E. Soil/Sediment 4- Other <br /> *. <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> W - - CONTAINERS u <br /> AND a m <br /> 5 <br /> m m nm PRESERVATION m v a <br /> m x g <br /> t g S =E°` ar== SAMPLE <br /> 7 - _ m1 m� ° '-- yCL �- EF ��ao NOTES ASSIGNED CONDITION - <br /> f r- T:: E� E� x11 t- �- M E ° BOTTLE UPON <br /> DATE tlME ; .,n _: SAMPLE ID �' N Z NUMBERS RECEIPT NOTES <br /> i 10632 I LI - <br /> t ONwfAw, _ ✓ U <br /> `} R :� 1 <br /> 91 <br /> _ <br /> y <br /> �r <br /> 7) <br /> NOTES 1 MISCEL NE( [YS Relinquished b Si nature ece'v gn ur to <br /> f ... r q Y= ( g ) <br /> f d 17/ (f <br /> } y /° <br /> f= Reli u's y: ignat r Received By: (Signature) Hate G-- <br /> Relinquished By: (Signature) Received By: {Si Date Time <br /> :Method ofShipt, rt r Description of Other Chatns'Of Custody Dispatched By. (Signature) Date Time Rab CBy: (Signature) Date <br /> cTransport Container Transported with this @ <br /> Chain (by Serial-No.) r"'~ U <br /> e T7 <br /> t'Send Leaf Rolts to` Naive -�� Ea UNIS � <br /> _ ) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> Q ATLANTA;. D "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) 926-8651TE r� <br /> FAX{4O4},959354 FAX(303) 799-0186 FAX(714) 757-0960 FAX{415) 960-0739 FAX(219) 926-7169 FAX <br /> BOZEMAN ` :7: ❑ HOUSTON ❑ KING'OF PRUSSIA ❑ PLEASANTON ❑ PORTLWD ❑ OTHER <br /> b TEL"(406)586 9496 :TEL(713) 556-1666 . TEL (215) 337-2551 TEL (510) 463-9117 TEL'(5Q 241-0262 TEL <br /> Awa FA)E:(406) 586m9724 L 'FAX(713) 556-0666 FAX(215)337-0560 FAX(510}463-2961 FAX (503 241-0486 FAX <br /> 1 CANONIE ENVIRONMENTAL SERVICES, CORP. + 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 a TEL PHONE (303) 290-8336 + FAX (303) 290-8013 <br /> SERIAL NO. WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy k�-,h- RF1/81" <br />