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� ws - w� w � w ■r. ww ww w ww ww �w w� w aw <br /> CANONIE ENVIRONMENTALI _rB P <br /> AIN-OF-CUSTODY RECORDROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME M (tA UN I r l t,ll �"`L. AISTV SAMPLERS ALEX (��'t SAMPLE: CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 9 3 3 01-()-7 QPatN —�F-i� DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER A 40-ml VOA Vial B Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BranklSpike 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Ptastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS CT <br /> AND <br /> wg <br /> PRESERVATIONa <br /> $ o 7r 0It I C nll_ SAMPLE <br /> Z I o NOTES ASSIGNED CONDITION <br /> >- BOTTLE UPON <br /> DATE I TIME SAMPLE IDv 7 NUMBERS RECEIPT NOTES <br /> Ian 0 S 1 ' � )I ' L l:_ ✓ ✓ +/ �/ a S � <br /> (,q ( 01<5- v ; ✓ <br /> brlL�fr) 1(103 S1'2- , - "L rn 1- t. I d <br /> 010 Z, <br /> ,�1�'i19(, �(? U .7�2'`tib - � it � '� ✓ ✓ I tr <br /> 04041+K 1 j{V u— -r. , i 1 V y ✓ I 1/ !� <br /> (q oto ( 1171 5C21-J17(0— 5 � � ✓ ✓ <br /> ,(lpiq Ll I ' <br /> r 54-1 5 E✓ ✓ I Y <br /> NOTES!MISCELLANEOUST ; l <br /> Rellnqu by (Signature) R erved By (Signature) Date Time <br /> Lt, } ��sll � � _0 <br /> 0 SS �l 2 <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> �� <br /> r1 Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of ShipmentDescription of Other Chains Of-Custody Dispatched 1 y (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> A(140N & C.Xc.e,)2- /5656 <br /> Send Lab Results to (Name) O 7`rC- rL44A P (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER /?10"f o <br /> TEL(404)951-0055 TEL (303) 790 1747 TEL(714) 757 1755 TEL(415)960-1640 TEL (219)926-8651 TEL` <br /> FAX(404) 956-9364 FAX(303) 799 0186 FAX(714)757 0960 FAX(415)960-0739 FAX (219)926 7169 FAX - <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)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) 290-8338 • FAX (303) 290-8013 <br /> SERIAL NO 15 . :� .5 opy WHITE Field Copy YELLOW Praiect Copy PINK Laboratory CREV SM2 <br /> � <br />