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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME 7H+EMRnI NIS �f2lC SAMPLERS A�C11 -I-L[S{LS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 �j�(PRlNT) DESCRIPTION CODES A. Ground water F. oil <br /> PROJECT NUMBER <br /> -1 L6`3�3 (�}i`-�� �.LQ�(� �.J2,�.� A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> . - (SIGN) B. Glass Llter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plastic 51)0-ml F.Other D. Rinseale I. Other 3- 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> q AND <br /> am Sm PRESERVATION 8 ° t0 <br /> m8 g oY n� <br /> E¢ N� _ SAMPLE <br /> m� • - -os_ :: �= F� 4u NOTES ASSIGNED CONDITION <br /> = �m E BOTTLE UPON <br /> DATE TIME SAMPLE ID N N = NUMBERS RECEIPT NOTES <br /> 023 t o fv►W-3 t114 WS tr ✓ <br /> 0-41k I 100 trwW—fo 4 ✓ ✓ <br /> NOTES l MISCELLANEOUS.. ReIIr q}�Ished by: (Signature) ' eived By: (Signature Date Time <br /> UPU 0411 J v � ie <br /> 041i By: (Signature) Received By: (Signature) Date Time <br /> L-AA AeAziJAL . <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 /> coo e-i 4 L 11i/ll . <br /> Send Lab Results to (Name): Ajots&9EV (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHER Allele <br /> TEL(404) 951-0055 TEL(303) 790-1747 TEL (714) 757-1755 TEL (415) 960-1640 TEL(219) 926-8651 TELZ <br /> FAX (404) 956-9364 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) 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(510)463-2981 FAX (503) 241-0486 FAX <br /> CANONIE E'•-" ONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITS 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX-'-93) 290- <br /> SERIAL NO. WHITE:Field Copy YELLOkAt Copy PINK:Laboratory Copy REV-9192 <br /> 1� 93 <br />