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CANONIE ENVIRONMENTAAHAIN-OF-CUSTODY RECORD OB PROJECT <br /> K (See Reverse for Instructions) NO <br /> PROJECT NAME Kd i4L'7"Y SAMPLERS 1416y SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> l (PRINT) DESCRIPTION CODES A Ground Water F Oil <br /> n l` <br /> PROJECT NUMBER l,T—33q cv-1 Q '�""`_ A 40-ml VOA Vial B Surlace water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H atank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 rn F Other D Rinseale I Other 3 24 Hour <br /> (SIGN) D Plastic Luer E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> $$$ AND 'o <br /> PRESERVATION <br /> a g� a: _ SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> EV BOTTLE UPON <br /> DATE TIME SAMPLE ID I Z NUMBERS RECEIPT NOTES <br /> a rid a 3 ✓ <br /> 0o <br /> NOTES 1 MISCELLANEOUS Rellnqu by (Signature) Re rued By (Signature) Date Time <br /> L++ _- 1� � i�-✓ �, ole-rte-9F S�:o Q <br /> s.' Relinquished By (Signature) Received By ( ignature) Date Time <br /> r� 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 /> �D/'Q� Transport Container Transported with this <br /> Gl(�� �� � Chain�� Serial No} <br /> � <br /> /VA- <br /> Send <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER EKOTHER MO 15R) <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL (415)960-1640 TEL(219)926 8651 TEL `2 Z <br /> FAX(404)956-9364 FAX(303)799.0196 FAX(714)757-0960 FAX(415) 960-0739 FAX(219)92&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)598-9724 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, SMITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX 303 290-8013 <br /> SERIAL NO 1 R R � 1 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 9182 <br />