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4rB CANONIEiENVIRONMENTAL AIN-Of=-CUSTODY RECORDPROJECT <br /> PROJECT NAME4 (See Reverse for Instructions) NO <br /> I�T€l ������� tJ[Ni-AC 1�,,/,,,erSAMPLERS lt'.'td ;20t?f= SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ff� (PRIN DESCRIPTION CODES A Ground Wafer F Oil <br /> PROJECT NUMBER ��- 33`7 0�-d7 /"'��-+� r-�f—fl A 40 ml VOA 8 surface water G waste I Standard <br /> (SIGN] B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Pas llc 500 ml F Other D Rinse is I Other 3 24 Hour <br /> {SIGN) D Piasllc Ltler E Soll/S dlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND : p <br /> S PRESERVATION Y >C 8='i3F <br /> SAMPLE <br /> = o "— iz 1 0q NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLEID § `� W ' a BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> uo 'If-, IMS 3 - { -- S 1✓ ✓ 4 c, s <br /> 1tT(i-1 1,j"2 •�, r iG Y I t ✓ d <br /> NOTES!MISCELLANEOUS '_t <br /> 1 t,r 1at,e t--v 2 I Relinquished b (Signature) R Ived By (Slgn�ture) Date Time <br /> LAC3 �R(�p� SP - 7��-S SP3-s` 3- '--z l -- -a--��,L/ ,�- y� �-,( - , <br /> Relinquished By (Signature) Received By (Signature) Date Tlme <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 /> ON &)&-kEk Q-00 LC-,W- L5(6as <br /> Send Lab Results to (Name) m GV"r rEte (Check Office Below) Verbals Requested Yes No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER I(? OTHER0571() <br /> TEL (404)951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TE G <br /> FAX(404)956.9364 FAX(303) 799 0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX 267` <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) 241-0486 FAX <br /> CANQNIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE 303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO C; I` 1- WHITE Field Copy YELLOW Projed Copy PINK Laboratory Copy REV 8192 <br /> 1JQ . L <br />