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rr rr r rr rr rr rr �r rr r r err r� �r �r <br /> CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD 8 PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME =�� SAMPLERS��t X �LPc� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 --7 DESCRIPTION CODES A Ground Water F 0d <br /> PROJECT NUMBER TA y ' 2��J r �}" �� � � �"' A 4o-ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate i H Blankropike 2 48 Hour <br /> RECORDERC Plasllc 5Do-ml F Other b Rmseate I Other 3 24 Hour <br /> (SIGN) D Plesilc Liter E SoffSedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> aIS AND $^ r <br /> ^$ isg^ PRESERVATION <br /> $ Sa k 4 a5 E SAMPLE <br /> u r au NOTES ASSIGNED CONDITION <br /> $ �- — ° BOTTLE UPON <br /> DATE TIME SAMPLE ID � fl z NUMBERS RECEIPT NOTES <br /> 32 r03 <br /> ✓ S v I I�OA -, ✓ um {322-9W A ✓ ✓ 1 ✓ o f !r l <br /> v ✓ ✓ I v aG <br /> i <br /> NOTES!MISCELLANEOUS a PC E ASt tJortE nquwy (Signature) Re Ived By (Signature) Data Time <br /> 2ATv 2>E~ vQU� s Relinquished By (Signature) Received By (Stgnature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> R-1 f t4- C 0 01 1�"2 N A <br /> Send Lab Results to (Name) t fel LQ TTe IZA'hs Ll (Check Office Below) Verbals Requested Yes ❑ No ❑ <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 <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415)960-0739 FAX(219)926 7169 <br /> ❑ 13OZEMAN ❑ 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)241-0282 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 '303) 290-8336 • FAX 303 290-8013 <br /> SERIAL NO L— ` WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />