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CANONIE ENVIRONMENTAL SAIN-OF-CUSTODY RECORD 0 PROJECT_ <br /> (See Reverse for Instructions) N0� + <br /> i <br /> PROJECT NAME ��(-}�` SAMPLERS A t L k �L 0 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT)- DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER �f 33 t! til- 1 �� - ��{ - -It(j 4 e � A 40 ml VOA Vial a surtacewater G waste l Standard <br /> (SIGN) B Glass Liter E Brass Tube C leachate H Blank/Spike 2 48 Hour <br /> C Plastic 500-mi F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) <br /> RECORDER ❑ Plastic Liter E Sol]/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS , <br /> m—a— <br /> PRESERVATION -1 x �— m I <br /> mm -m li- <br /> ` Jr a8 $� [ SAMPLE <br /> � � m d �1 {� �� �� �"o� NOTES ASSIGNED CONDITION <br /> Em m a LL r- T> BOTTLE UPON <br /> DATE TIME SAMPLE ID = 7 �. �� z NUMBERS RECEIPT NOTES <br /> )t�ILr) tt u / 1't eA.S <br /> pCF'l277�77 %4. - � a � x ✓ ✓ ll 1 ' ( 1312 nr�fti��� � <br /> CTl1G !- �. is 1 i� i` /y / tf t� ✓ V �Sf41P <br /> _ / p <br /> (A411-it ✓ 1 r�r S <br /> 10 (t )t �r' t( +f 1l ti)A -L� <br />� 1 <br /> NOTES!MISCELLANEOUS ( , Relinquished by (Signature) Received By`(�ignature) Pate Time <br /> .�= >LGI��i � t �Hlttr Lr- �_Q`_ <br /> &l.0 -] C-)rz.t= Relinquished By (Signature) Received By (Signature) Date Time <br /> ���L' 5� � •J t_�� I��T� f} ��trlt�i Relinquished By (Signature) Received By (Signature) Date Time <br /> i7 k t1r1� <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 /> lj f o t i Chain (by Serial No <br /> Q <br /> } <br /> Send Lab Results to (Name) rn )J ~(=fit lr� r` (Check Office Below) Verbals Requested Yes ElNo <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER lr] OTHER r,``lc '1 f <br /> TEL(214) 770-1800 TEL (303) 7901747 TEL(714) 757-1755 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) 5318886 FAX (215) 337 0560 FAX (510) 463-2981 FAX (503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 7701800 • FAX (214) 770 0249 <br />