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B PROJECT ENVIRONMENTAL' RAIN-OF-CUSTODY RECORD <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME CTLe-0 5'-M11tl" Uf-AIL- SAMPLERS i4[.—r-;K SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> /,(PRINT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER 4'Sr'-36`l XJ e: / A. 4o-mlVOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. StanklSpike 2. 48 Hour <br /> RECORDER C. Plastic 500-ml F.Other D. Rinseale t Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoillSedimenl 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> ANO m <br /> m eg—g PRESERVATION — x mR = if <br /> i5 ¢ SAMPLE <br /> ou NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE IDS ' ~m z NUMBERS RECEIPT NOTES <br /> 17- M40 Mw- I A ✓ <br /> DIU-17 !LSO N uj- A, 192V1 V <br /> D1A30ft tAW-3 4 Rz ✓ ✓ <br /> 012VI L230 MVJ-5 <br /> IDINA1112'L0 Mut-6 <br /> NOTES l MISCELLANEOUS Relinqulshe : (Signature) c I B S' na Date Time <br /> LA% �EC,ivc)iA /0 <br /> Relinquished By: (Signature) elved : (Signature) Dat6 Time <br /> Relinquished By: (Signature) 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 /> Transport Container Transported with this <br /> D yNA-M%(,S . Chain (by Serial No.) <br /> ez0 112-VIS V-1 1`-'t S D (0 <br /> Send Lab Results to (Name): Wf-. EV (Check Office Below) Verbais Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER elOTHER MZh��70 <br /> TEL (404) 951.0055 TEL (303) 790-1747' TEL(714) 757-1755 TEL (415)960.1640 TEL(219) 926-8651 TEL <br /> FAX (404) 956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415)960-0739 FAX (219) 926-7169 FAX ZO 9'--5TS <br /> ❑ 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) 586-9724 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 /> /1 fl <br /> SERIAL NO. 1 � q WHITE:Fleld Copy YELLOW:Project Copy PINK:Laboratory Copy REV 8192 <br />