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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB <br /> �PRROyJ•ECI <br /> f (See Reverse for Instructions) NO. <br /> PROJECT NAME h0(D� Or SAMPLER I",fe`--J 1l• !'n-Gl'fet"F° SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 11' DESCRIPTION CODES A. GrounC Water F. Oil - <br /> PROJECT NUMBER iop�� _0 i ur�r A;> �f.�c A a0-m1 voA vial B. surface water G. waste 1. Stantlartl - <br /> (SIGN) B.-Glass Liter E. Bread Tub C. Leachate H. Blank/Spike 2. 48 Hour 1 <br /> l 1, REC©RDER I - c. Plastic 500-ml .Omer_ o, Fliorreat. I. Other_ a. 24 Hour <br /> -. II l i (SIGN) ' — '. p. Plastic Liter SaiVSetli 4. Omer <br /> n ! I II I MSEnoF ANALYSIS EQUESTED E LABORATORY USE ONLY <br /> CONTAINERSAt <br /> l <br /> 1 <br /> `g <br />•. i �, � I I � I I � �88 ¢— PRESEVR <br /> RATION <br /> SAMPLE <br /> `tI eH "< Ndr ES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME' i. t. SA PLS ID NUMBERS RECEIPT NOTES <br /> I r . <br /> i <br /> 0 1 I <br /> II I I <br /> II <br /> nI <br /> II <br /> i <br /> Y <br /> 1{ I <br /> Ti <br /> I k—1 <br /> NOT StMISCEL N u I " - Relinquished by (Signature) e" By: ign re) at Time <br /> P 7 <br /> u- I j jlat <br /> elinquished By: (Signature) Received By:(Signature) Date Time <br /> 5 ii: I I I I <br /> Relinquished B : (Signature) Received B (Signature) Date Time ` <br /> i <br /> #` q Y ( 9 1 Y� ( 9 ) <br /> M If n of j Othr Chitins-911-C tody, Dispatch BY: (Signature) Date Time. . Received for lab By: (Signature) ate Time <br /> Trfns rt CIntai r Tr nspSrted with(his <br /> C ain (by SArlal No.) � �2 <br /> t ,r <br /> Seng Lab desu is to (Marne : tLGI a r { ! (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ <br /> PO. <br /> j I I'❑ ANjMATEO I 7 ❑ IRVI E ❑ ORLANDO ❑ OTHER <br /> TEE(219)9r26-8 1 I ! EL 415)1573-8012! TEL(714)757-1755 TEL(407)856.7428 TEL <br /> FA),C(210) 9r6-769 - ! I AX(415)1573-$i FAX(714)752-0960 \. - FAX(407)855-2595 FAX <br /> ❑ IDrp-yq"-VE" I I- I _ I❑ kINd OF I RU�SIAI I ❑. HOUSTON \� ❑ MT. VIEW El OTHER <br /> - TEL(303) 790-1747 TEL(215)337-2551 TEL(713) 556-1666 TEL(415)960-1640 TEL <br /> FAX(303)799-0186 FAX(215)337-0560 FAX(713)556-0666 FAX(415) 960-0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, CA 95206 • TEL.(209) 983-1340 • FAX (209) 983.0304 <br /> SERIAL NO. U1223 <br /> a WHITE'Field Copy YELLOW:Protect Copy PINK:Laboratory Copy _ <br />