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. CANONIE ENVIRONMENTAIWHAIN-OF—CUSTODY RECORD �AB PROJECT <br /> (See Reverse for Instructions) Nc� <br /> PROJECT NAME PGr RA SAMPLERS Aoj7 S-o—A A <br /> _._ .�, SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> h P tNT) DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER UEk Oi10 – tAVIM A 44m1 VOA Vial E Surface water G waste 1 Standard <br /> {SIGN} B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 5M.1 F Other D Rinseate t Other vb- 3 24 Hour <br /> (SIGN) D Plastic Liter E Scottsedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> AND g r <br /> --8— <br /> PRE <br /> SERVATION JYg H <br /> SAMPLE <br /> _ j� – NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID "e g– BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> oVI9 0 5' P6- t1 E Tow- A A 3 1 14 v <br /> se Ga E w -- A A . f L <br /> 3S6 r(z q 4 Al3 f <br /> f rair"15, 111ti, E 06/ A 3 1 J <br /> $o"r PG e Ot✓- r A <br /> 3 00 (r 4 C w - 6 A < V <br /> nr3 (r 9E T ow — 3 A f 3 I ti <br /> a o (rq E T A 14 113 <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) Rece a By ig Date Time <br /> SRe she y e teed By (Signature Date Time <br /> Relinquished By Stgnature) Received By (Signature) Date Time <br /> Method of Shipment Descnphon of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date 1TTIMB <br /> Transport Container Transported with this ' <br /> Chain (by Serial No) <br /> r3�s <br /> Send Lab Results to (Name) D 411r� (Check Office Bel ) Verbals Requested Yes ❑ No O <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714)757-1755 TEL(415) 960.1640 TEL(219)926-8651 TEL?.tqF1 F-3s dl <br /> FAX(404) 956-9364 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX ; �P31; <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)2410282 TEL <br /> FAX(406) 586-9724 FAX(713)5560666 FAX (215)337-0560 FAX(510)463-2981 FAX(503)2410486 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. A r"' r i n WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy REV 8192 <br />