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CANONIE ENVIRONMENTR `Y�'YCHAIN-OF-CUSTODY RECORD .LAB PRo,rFcT <br /> (See Reverse for Instructions) <br /> � QNO. - <br /> PROJECT NAME Sjn At:►ti_�1-� SAMPLERS ►J��1s�t+Y �." SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES 4 <br /> u [� CLX <br /> IJ(�11 DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER —P "9 - I XT) J ((7/1� A. 40-ml VOA Vial B. Surface Water G. waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. BlanklSpika 2. 48 Hour <br /> RECORDER — • S lel:. C. Plastic 500-ml F.Other D. Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> v ll JJ g AND d o 6 <br /> a PRESERVATION v Q @ d <br /> �$$ a �8 X.1 t; 8Y a— <br /> $ .41a s yU=L SAMPLE <br /> Fm �`o- NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID � z NUMBERS RECEIPT NOTES <br /> nA w b A V Al al 31. Y IX <br /> NOTES/MISCELLANEOUS Relinquished by: (Signature) Re eived Ty: (Sigl�xrA,7 Date Time <br /> /.� Felin shed By: (Signature) Received By: (Signature) Date Time <br /> Relinqui By: (Signature) Receives! ignature) 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 /> Chain (by Serial No.) �P(I&5 <br /> PaI�, »r�1Pn �a1P� ala , r 7 J('0,41— ubr�)10s ! <br /> Send Lab Results to (Name): / 1M ex J-T (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER b IRVINE ❑ MT. VIEW ❑ PORTER 0 OTHER Z4-c-Olm— <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714)757-1755 TEL(415) 960-1640 TEL (219) 926-8651 TEL %4 7T1?rc, <br /> FAX(404) 956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX (415) 960-0739 FAX (219) 926-7169 FAX <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 /> SERIAL NO. 1 h A 7 7 WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8192 <br />