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-- CANONIE ENVIRONMENTAL` HAIN-OF-CUSTODY RECORD r` B PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME STOU-T-W SMLTIA CLJN__ SAMPLERS ALE. L I`L-nPsS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> V 1 � �(�PRINI)_ DESCRIPTION CODES A. Ground water R oil <br /> PROJECT NUMBER G 4 �S q �� �� /'�V—'r�+ 7t A. 40-ml VOA Vial B- Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E- Brass Tube C. Leachate H. HlanklSpike 2. 48 Hour <br /> RECORDER C. Plastic 500-ml F Other D. Rinseste I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoillSedimerl 4- Other <br /> NUMBER of ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS O <br /> `o AND <br /> PRESERVATION <br /> 8 0� z wr E t=t SAMPLE <br /> mm c '-P �� a m"<o NOTES ASSIGNED CONDITION <br /> Ev a �y E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID . a 0= NUMBERS RECEIPT NOTES <br /> 41 A 2 1 1 Alf Iq a ,/ - <br /> MAI LQy00— W- A v ✓ ✓ <br /> NOTES 1 MISCELLANEOUS Relinquished by: (Signature) Received By: gnatur Date Time <br /> LAB SCQUOIA -rte,' /,;? � <br /> Relinquished By: (Signature) Recei d y: ign Lure) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Dale Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) AC,;-Y6��� Q�`F9 /Z � <br /> C,ov2t E W L.E� 15 7 7d 7-CJ <br /> Send Lab Results to (Name): —=!E (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER 5 <br /> TEL (404) 951-0055 TEL(303) 790-1747 TEL (714)757-1755 TEL(415) 960-1640 TEL (219) 926-8651 TELA <br /> FAX (404) 956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 1 A <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406) 566-9496 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 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290 8013 <br /> SERSAL NO. T") S3 WHITE:field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8192 <br />