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CANONIE ENVIRONMENTAL 6"IAIN-OF-CUSTODY RECORD � B PROJE.,T <br /> (See Reverse for Instructions) NO. <br /> 57kfJ 67i7H ���Jii R- At.Ex kr..a,e.Es �. <br /> PROJECT NAME SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 9 11 -3� PRt1�lT DESCRIPTION CODES A. Ground Water F. Oli <br /> PROJECT NUMBER 7� A. 40-ml VOA Vial B. surface Water G. waste 1. Standard <br /> (91 N) B. Glass Leser E. Bras@ Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic Sol)-ml F.Other D. Rlnseate 1. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. SoIVSedimenl 4.,Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> //�� U g <br /> § AND h, V 8_ F e g <br /> PRESERVATION I >( r <br /> r , A 8 S r�- � SAMPLE <br /> I NOTES ASSIGNED CONDITION <br /> i Ev BOTTLE UPON <br /> DATE TIME SAMPLE ID :5I 8 = NUMBERS RECEIPT NOTES <br /> 032q I S' 01x- M77 5 ✓ <br /> -T <br /> a3xy <br /> NOTES!MISCELLANEOUS Relingyls by: (Si ature) Rec ' i r 1 T' U <br /> LAB a ki- T,CA L M <br /> S� OQoi A � y h lure} Received By: (Si(Signatu Date Time <br /> Relinquished By: (Signature) Received By: gna e) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signal Date Time Received for lab By: (Signatup$�-I� e Tlme <br /> Transport Container Transported with this <br /> Chain (by Serial No.) J <br /> Send Lab Results to (Name): E (Check Office Be! Verbals Requested: Yes ❑ No ❑ <br /> ❑ DALLAS ElDENVER E] IRVINE ElMT. VIEW ElPORTER = OTH ESGpc- <br /> �UrJ <br /> TEL (214)770-1800 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)996-8651 TEL <br /> FAX (214) 770-0249 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) 589-8686 TEL(215) 337-2551 TEL(510) 463-9117 TEL(503)241-0282 TEL <br /> a ti FAX(406) 586-9724 FAX(713) 531.8886 FAX (215) 337-0560 FAX(510) 463-2981 FAX(503) 241-0486 FAX <br /> iCANONIE ENVIRONMENTAL SERVICES, CORP. - TWO GALLERIA TOWER - 13455 NOEL ROAD, SUITE 1500 - DALLAS, TX 75240 - TELEPHONE (214) 770-1800 - FAX (214) 770-0249 <br /> SERIAL NO. e) A n p i WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV. 11193 <br />