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CANONIE ENVIRONMENTA*RAIN-OF-CUSTODY RECORD AB PROJECT <br /> (See Reverse for Instructions) <br /> PROJECT NAME q 1L Rc I- SAMPLERSTU� Lu;}c+t-r+a>s� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P HT1 DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER A 40-mt VOA Vlal B Surface water G waste i Standard <br /> (SIGN) B Glass Liter £ Brass.Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER 7a"•'+ C Plastic 500-ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E Soll/Sediment 4 Other <br /> NUMBER OF A LYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> i g AND <br /> $ 'agg PRESERVATION <br /> $ 8 S$ ° ai_ SAMPLE III r nT rJ <br /> a o NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID ' r t� BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> win T17. Z k/ ov-- MW't X t <br /> I <br /> I <br /> I <br /> NOTES/MISCELLANEOUS E—i <br /> Relinqut bed by (Signature) R elved B (Signature) D to Ime <br /> t -�- �� <br /> ne quished By (Signature) Received By ( ignature) Date Time <br /> r <br /> a — <br /> Rellnq ed By (Signature) Received By (Signature) Date Time <br /> ful�had of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> 2 v <br /> 1 yL V, Transport Container Transported with this <br /> Loin-%,C-r-- ILL- CA\es, Chain (by Serie o) <br /> Send Lab Results to (Name) St v c) �q Jacr.����C N Check Office Below)) Verbals Requested Yes No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER MC] 4 <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX (415) 960-0739 FAX(219) 926-7169 FAX <br /> ❑ BOZEMAK ❑ 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)2410282 TEL <br /> FAX(406) 586-9724 FAX(713) 556-0666 FAX(215) 337 0560 FAX (510) 463 2981 FAX(503) 241-0486 FAX <br /> GANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE '303) 290-8336 a FAX (303) 290-8013 <br /> SERIAL NO WHITE Field Copy YELLOW Project Copy PINK Laboratorycopy REV 8192 <br />