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CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD 1011 PROJECT <br /> _ (See Reverse for Instructions) NO <br /> PROJECT NAME SAMPLER ��`� � TLC7��' <br /> 4 L t SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ____�� <br /> �/! �( (PRINT��' '� DESCRIPTION CODES A Ground walar F ou <br /> PROJECT NUMBER Cf L `f _Q!I f_� /' y�, T�C��1 A 40-ml VOA Vial a Surface Water G Waste I Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H Btank/Splke 2 48 Hour <br /> RECORDER C Plastic 5Mml F Other D Rlnseate I oihar 3 24 Hour <br /> (SIGN) D Plastic Liter E Soli/Sedlmeni 4 Other <br /> NUMBER OF A(JALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> g AND � $_ <br /> PRESERVATI N Y � �e � �_ <br /> x h+ Y SAMPLE <br /> _ ;� .-• NOTES ASSIGNED CONDITION <br /> ° BOTTLE UPON <br /> DATE TIME SAMPLE ID $� z NUMBERS RECEIPT NOTES <br /> oiosl& M W - A if ✓ I It Dq ✓ <br /> +05 ilIq+ S w . A P 3 v <br /> 20 N1 ku- A111/11V I ✓ r v <br /> 4 ! Vi V 1 ✓ <br /> 61 g5 W 5 R ✓ 3 <br /> 0lo Jy4A t.1 VJ 6 P ?, I/ ✓ ✓ ,/ <br /> 010616 350 ,.J A 3 r <br /> i <br /> NOTES l MISCELLANEOUS A- IL rn!.r 9E PO 0 _�,q`n P!C-7Relinquished-by (Signature) Re Ived By (Signature) Date Time <br /> •-P-6��-�-✓ rs 00 <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Pece+ved By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Dale Time Received for lab By (Signature) bate Time <br /> Transport Container Transported with this <br /> f1 <br /> Wo <br /> Chain (by Serial NO) <br /> 42� <br /> i <br /> Send Lab Results to (Name) Ca},A Lu I Te R t,\0, (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER Ug"OTHER ffiobESr() <br /> TEL(404)9510055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219)926 8651 TELA r-?—'I <br /> FAX(404)956-9364 FAX(303) 799 0166 FAX(714) 757-0960 FAX(415)960-0739 FAX (219)926-7169 FAX70q1579--122' <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)2410282 TEL <br /> FAX(406) 586-9724 FAX(713) 556-0666 FAX(215)337-0560 FAX (510)463-2981 FAX (503) 2410466 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8335 • FAX (303) 290-8013 <br /> SERIAL NO F 7 A WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br /> �J r i (t <br />