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CANONIE ENVIRONMENTALOAIN-OF-CUSTODY RECORD OB PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME - l� _ _ _ _ _ _ SAMPLERS /qQTH9tN SLa^44 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> fPRLN DESCRIPTION CODES A Ground Water F On <br /> PROJECT NUMBER 99 - 3 3 `? - 01 TArk I o 5 A 40-ml VOA Vial B Surface water G Waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H slank(Spike 2 48 Hour <br /> RECORDER C past le SWrn F Other D Rinseale t Other 3 24 Hour <br /> (SIGN!) D Plastic Liter E WI/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> gg AND <br /> saa 8— PRESERVATION _ <br /> 8 l g 4 g Y SAMPLE <br /> d } < ASSIGNED CONDITION <br /> n �S NOTES <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID G NUMBERS RECEIPT NOTES <br /> - 0 - C 3 <br /> 13s o c3 l <br /> �s , o _ I <br /> � gs 33 o k 3 1 <br /> I <br /> NOTES I MISCELLANEOUS Reh fished by ($Igaature) Received By (Slgnatur ) Date Time <br /> Relinquished y (Signature) calved By ( ignature) Date Time <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 /> Send Lab Results to (Name) IZ b lyt&— ?:L-- (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TEL 'L05 - P?S P-0 <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219)926-7169 FAX Jbg-F.?I- <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PL.EASANTON ❑ 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(514) 463.2981 FAX(503)241-0486 FAX <br /> I CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 is ENGLEWOOD, CO 80111 a TELEPHONE 303) 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO 15530 WHITE Field Copy YELLOW I'Mect Copy PINK Laboratory Copy REV 8192 <br />