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CANONIE ENVIRONMr:NTAC"•CHAIN-OF-CUSTODY RECORD -;LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> a-=r <br /> PROJECT NAME".610 Sr.nt C-1t A SAMPLERS }�LEk Tr f,,,— . SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> {PRI x <br /> DESCRIPTION CODES A. Ground Water F. OR <br /> PROJECT NUMBER -0l- -�-sC- } 5�.✓ A 4o-ml VOA Vial B. surraea water G waste i. Standard <br /> (SIGN) - B- Glass Liter E. Brass Tube C. Leachate - H. BlanklSpike 2. 48 Hour <br /> 1 RECORDER - - _C. Plastic 506-m1 F-Other D. Rinseate 1. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER Of ANALYSIS REQUESTED L. ORATORY USE ONLY <br /> CONTAINERS - <br /> - c AND <br /> m.fig PRESERVATION m aR a a <br /> �a x4 <br /> c9g o8 w� a�¢ of=v SAMPLE <br /> m= m 1 "' Mm E� m°d0 NOTES ASSIGNED CONDITION <br /> E > BOTTLE UPON <br /> BATE TIME SAMPLE ID y N z NUMBERS RECEIPT NOTES <br /> OJIM 10-0 q a ! - <br /> mai Lo pi A v ,f <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) Received By!Tgn tur Date Time <br /> SEOuGIA <br /> Relinquished By: (Signature) Re ce' d By: ignature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method.of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signatut•e) Date Time : Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) <br /> 4 0 k :E �Gr j '� . -�— .✓ DAI/F9 /�� v: � 4 is-0 fart <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No ❑. <br /> ❑ ATLANTA " ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER Mobc <br /> TEL(404) 951-0655 TEL(303) 790-1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TELA S79-z z? <br /> FAX(404) 956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415) 960-0739 FAX-(219) 926-7169 FAX�q-Jr - - Z�5 <br /> Gl BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ 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)586-9.724 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 60111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO. 14 <br /> 5-18 <br /> - i8 WHITE:Field Copy YELLOW:Project Copy PINK:laboratory Copy •REV.8192 <br />