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r - - B PROJECT <br /> �, CANONIE ENVIRONMEIV�'AL'�HAIN OF CUSTODY�'� �RD! � <br /> r _ (See Reverse for Instructions) _��. /! f NO. <br /> PROJECT NAME W r`R A SAMPLERS AA;T/i°^'y SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> LlI 3 ��rK RINT) r��L DESCRIPTION CODES A Ground Water F Oct <br /> PROJECT NUMBER V J A 40-ml VOA Vial B Surface water G Waste 1 Standard <br /> (SIGN B Glass Liter E Brass Tube C Leachate H Blan1dSplk h 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rinseate i Sire, _Ill_ _ 3 24 Hour <br /> (SIGN) D Plastic Liter __� E SoillSedimera 1 rT 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AN a <br /> PRESSN €� � 4 I_ <br /> € $ x£ SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> UPON <br /> DATE TIME SAMPLE ID V ~ z NUMBERS RECEIPT NOTES <br /> U I ' U t✓ Q�- r Aff <br /> ,,c199s I�l1 u P , T W v — - r — <br /> , <br /> NOTES if MISCELLANEOUS o Relln utshed by (Signature) R Ived By Signature) Date Time <br /> �>w %v� <br /> Relin ish "y (Signature) Relcety"By (Signature) Date Time <br /> R Iinqulshed By (Signature) Received 9 (Signature) Date Time <br /> Me hod of Shipment Description of Other Chains-Of-Custody Dispatched By (51 ature) Date Time Rh <br /> e sed for lab By (Signature) Date Time <br /> !2. ned with this <br /> �� y Se <br /> Transport Container Chain(briial No) <br /> '(�.1� � (f 0 Q L E t�. �J�1 �L�I( �le�.,1 0`9`/0 <br /> Send Lab Results to (Name) t�N� �`" F t (Check Office Below) Verbals Requested Yes El No El <br /> ❑ ATLANTA „ [I DENVER El IRVINE 1:1 MT VIEW El PORTER l OTHER <br /> TEL(404)9510055 TEL(303)790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL T ` <br /> u <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415)960-0739 FAX(219) 926 7169 FAX <br /> 0 BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586 9496 TEL(713) 556-1666 TEL(215) 337 2551 TEL(510)463-8117 TEL(503) 241-0262 TEL <br /> FAX (406) 586 9724 FAX(713) 556-0666 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 1303) 290-8336 • FAX (303) 290-8013 <br /> TRIAL NO -1 (t (� _r f" WHITE Field Copy YELLOW Project Copy PINK I aboralory Copy RFV W9 <br />