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CANONIE ENVIRONMENTAL &AIN-OF-CUSTODY RECORD 013 RROJECf <br /> �/ (See Reverse for Instructions) No <br /> PROJECT NAME , l/�`l< �P,LT _ SAMPLERS ISI-x X- T'LC ALC >- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRP?_ DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER 94 33"1 01- 10— A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGNi B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> C Plastic 500 ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN)RECORDER D Plastic Lher E Soil/Sedlmenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS ' u <br /> otM <br /> AND c <br /> �m <br /> s m 6b PRESERVATION 8 m <br /> 5� g ax SAMPLE <br /> vu a NOTES ASSIGNED CONDITION <br /> 3 E BOTTLE UPON <br /> DATE TIME SAMPLE ID �' In Z I NUMBERS RECEIPT NOTES <br /> ~t fzq Z f I I { ✓ <br /> til 14,1 1 zz bA ixlwill Izi—q— <br /> �- 3 ✓ ✓ µ To <br /> 'L 1/ !/ Pt es <br /> Ho r <br /> NOTES 1 MISCELLANEOUS + Relinquished by (Signature) Received By (Signature) Dater Time <br /> Relinquished By (Signature) Rea Ived By (Signature) Date Time <br /> c'• Si1}ft �� fll.='TecTf�� U1tr <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 /> �4 <br /> Transport Container Transported with this 0111 Chain (by Serial No) <br /> Send Lab Results to (Name) rt l= (Check Office Below) Verbals Requested Yes El No <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ M7 VIEW ❑ PORTER <br /> OTHER <br /> TEL(214) 770-1800 TEL(303) 790-1747 TEL (714) 7571755 TEL (415) 9601640 TEL(219) 926 8651 TEL <br /> FAX(214) 770 0249 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) 589 8686 TEL(215)337 2551 TEL (510) 463 9117 TEL (503) 241-0282 TEL <br /> FAX (406) 586-9724 FAX(713)531 8886 FAX (215) 337 0560 FAX (510) 463-2981 FAX (503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770-1800 • FAX (214) 770-0249 <br /> SERIAL NO r) WHITE Reid Copy YELLOW Project Copy PINK Laboratory Copy REV 11193 <br />