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r41i.w ®rlersy IM011044 <br /> CANONIE ENVIRONMENTAL CHAIN-OR-CUSTODY RECORD LACI PROJECT <br /> (� lI <br /> (See Reverse for instructions) NO _ Q,�_��f <br /> PROJECT NAME _ILaase–�li — — SAMPLERS �O'A Ut'),14P! __ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> jA 1 ni rl - DESCRIPTION CODES A U w.f wJlel f cel <br /> PROJECT NUMBER„ K►a ra Sri l?�SQc _ )'1 Z A 40 m1 V0A V141 a SII IIw W.W r W"'. 1 Si#-Wd / <br /> ISi� y e GlAs.1 1W E 814s5 t." r- t. +.1. ti M"s S"A. 2 48 naw <br /> RECORDER C P'4sfk S00 i 1 r lleo M , R—.1. 1 Omw 3 24 HJ i <br /> (SIGN) D Plastk LOBI 4 Olnel <br /> Nursti[R0E ANALYSIS REQUESTED LABORATORY USE ONLY <br /> (ONIAIWfISAND <br /> — <br /> 11 <br /> Y # <br /> 'H Y6 PRkS1FHVEfirAliON i. 3u D g 1; <br /> 8 4 SAMPLE <br /> N01ES ASSIGNED CONDITION <br /> 130"LE UPON <br /> DATE TIMESAMPLE Ip • a a LL = NUMBERS RECEIPT NOTES <br /> NOTES!MISCELLANEOUSRul1it/lul ed y 1 81urPl Rf Celved By (Stgnarure) DaleTime <br /> ed — <br /> elan/gals y { gnature) Ftecewed By ISlgnature) Date Time <br /> Retin4tulshed By (Signature► Received By (Signature) {late Time <br /> Method of Shipmerl Description of Other Chains 01 CUStodyT Dispatched By (Signature) Date Time Received lot lab B y(Signalur le Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) I f <br /> -- - -- - ---- ` -----_—_ ------ -- -- - - -7 51 /Eid <br /> (Name) _ rwn5. or z�° ,c� 160T T-a.,�,x6 Q.y - (Check Qtttce Betow) Verbals equPsf94 <br /> Send Lab Results to Name �_— _ ___ <br /> N <br /> ❑ PORTER SAN MATEO IRVINE ORLANDO OTHER <br /> TEL(219)926-8651 TEL(415)5738012 CEL f714) 7571755 1E (407) 65674128 TEL[t!r41 637 0170 <br /> FAX(219)926 7169 FAX(415)573 5654 FAX(7141 757 Or-60 FAX(407)855 2595 FAX(1134 627 11 Y b <br /> DENVER KING OF PRUSS4, HOUSTON MT VIEW OTHER <br /> TEL (303)7901747 TEL(215)337255t TEL (713► 556 1666 LEL (415)960 1640 TEL _ <br /> FAX(303) 799 0186 FAX(215)337 0560 FAX(713}556 0666 FAX(4 t5)960 0739 FAX _ <br /> �CANONIE ENVIRONMENTAL LABORATORY • 212_FRANK WEST CIRCLE SUITE A * STOCKTON CA 95206 * TEL(209)983 1340 • FAX (409) 983 0304 <br /> SERIAL NO n R ,� i�ttnE ix.W CMIr YEI LOW F.0,"fi PIFIK kal..ai.V C<Ipr <br />