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CANONIE ENVIRONMENTAL 'VHAIN-OF-CUSTODY RECORD '-IAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME 'OKIJ &AxTN CArYd. SAMPLERS' ALEX �Z-��� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> C(4�30 OI-I 0 r e_ SPRINTf DESCRIPTION CODES a Ground water 1 011 <br /> PROJECT NUMBER _ �+ 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. aB Hour <br /> RECORDER C. Plastic 500-ml F.Other D. Rinseale I. other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soi[lSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LA60RATORY USE ONLY <br /> • CONTAINERS <br /> m o AND m <br /> a <br /> m.fi8m PRESERVATION m� mg " <br /> E q 2 m m <br /> 8m 8m LLt �m N4=r SAMPLE <br /> z 320 _ � ac? NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID �V LL <br /> NUMBERS RECEIPT NOTES <br /> MO —2az I 11K IE� <br /> '70A-T ILI5 -3 1 <br /> �fL9 110 �- _ <br /> NOTES 1 MISCE NEOUS Relinquished by: (Signature) livellrSignature) Date Time <br /> 7 L 13f <br /> ��gt � 0 Relinquished By: (Signature) eive By: (Signature) Date Time <br /> Relinquished By: (Signature) 7 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 /> ` r1 Transport Container Transported with this L f}rZ`i <br /> V�.T►'-Tt' � nn Chain (by Serial No.) � 7CwLe <br /> 1L <br /> Send Lab Results to (Name): e71,NNG (Check Office Below) Verbals Requested' Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER +d <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL (219) 926-8651 TELZ� <br /> ,FAX (404) 956-9364 FAX (303) 799-0166 FAX(714) 757-0960 FAX(415) 960-0739 FAX (219) 926.7169 FA ZE <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEAS ANTON ❑ 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 /> 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 B0111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. 1 /1 c /A q WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.41192 <br />