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i <br /> CANONIE ENVIRONMENTALOar <br /> AIN-OF-CUSTODY RECORD Nolob PROJE-PT <br /> (See Reversenstructions) ` ' <br /> PROJECT NAME T 1 L1 Re A Lt y SAMPLERS fie" '7 �, SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1, _3314 <br /> �� DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER "i A 40Lml VOA Vial B Surface water G waste 1 Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plas[ic 500-ml F Other D Rinseate I Other 3 24 Hour <br /> r {SIGN) , D Piaslic Liter E SodlSadiment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED' LABORATORY USE ONLY <br /> CONTAINERS a+� <br /> AND $ <br /> 3—lig PRESERVATION �Y "Y <br /> 8 F / g SAMPLE <br /> g NOTES ASSIGNED CONDITION <br /> $ `4.. $��U BOTTLE UPON <br /> DATE TIME SAMPLE ID NUMBERS RECEIPT`'' 1-41-,NOTES <br /> ( 4 <br /> 2 135 Alf 13 V7� r3 I Ll <br /> -all At g <br /> 2 ,�ti <br /> T <br /> f , _ <br /> s <br /> 5 <br /> i <br /> 1 , <br /> NOTES/MISCELLA EOUS 1 7,0, or �IF,, ',t 1 t� RellnSee +au hed by (Signature) R ived By {Sig tur D to Time <br /> Q fie, e:c �brn �.�w+1 pelmqulshed By (Signature) Received By (Signature) Date Time <br /> ' q hed B 5 nature) Received By {Signature) Date Time <br /> paAce0007-6-A"^ Q14l 64Z `�- z ' <br /> i <br /> Method of Shipment Description of other Chains-Of-Custody Dispatched By (Signature) ! Date r Time Received for lab By (Signature) Dale Time <br /> y! Transport Container Transported with this <br /> L06z7q <br /> � Chain (by Serial No) r :� i ,d <br /> cou IZt F_ e— �.YJCJI.�G/ i r ; Uo( <br /> �'_'`3J (, 1) 1' <br /> i <br /> --send Lab Results to'(Name) d � (Check Office B law) Verbals Requested Yes El <br /> ❑ ATLANTA ❑ DENVER ❑ IRIVINE ❑ MT VIEW ❑ PORTER l OTHER <br /> TEL(404)951-0055 TEL(303)7901747 °r TEL(7t4) 7571755 TEL(415)960-1640 TEL(219)926 8651 i TEL Z�/ <br /> FAX(404)956-9364 FAX (303)799-0186 FAX(714) 757-0960 i FAX(415)960-0739 FAX(219)926-7169 , , FAX 4 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND 17- ❑ OTHER <br /> ` ` " <br /> TEL(406)586-9496 TEL(713) 55$-1666 - YEL(215)937-2551, �. �, " 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 J WHITE Field Copy YELLOW Protect Copy PINK Laboratory Copy REV BM2 <br />