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CANONIE ENVIRONMENTAL CAIN-OF-CUSTODY RECORD ! PROJECT <br /> (See Reverse for Instructions) NO. <br /> p <br /> PROJECT NAME f ' SAMPLERS E_V SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER-9 <br /> � 2,+ 13' 01-10 !•-�� ._- 47•--h P_j A. 40-ml VOA Vial B. Surface Water G, Waste 1. Standard <br /> �^ (SIGN) B. Glass Liter E. Brass Tube G. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C- Plaslic 500-m1 F.Other D. Rinseate I. Other 3. 24 Hour <br /> {SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> GONTAINERS <br /> AND <br /> - qm PRESERVATION d^ �°' rQ= ms nr• - <br /> `� mY a� sd SAMPLE <br /> �,�__ . <br /> _ NOTES ASSIGNED CONDITION <br /> m v 0v Ei=$ -�0 <br /> E� a ` LL �ll;. -� ra 2 2 E >v BOTTLE UPON <br /> DATE TIME SAMPLE ID y N P{ N z NUMBERS RECEIPT NOTES <br /> IVA <br /> w it <br /> 7 Nt�I <br /> V Pori 14%7 <br /> NOTES!MISCELLANEOUS Relinquished by: (Signature) Received By: (Signature} Date Time I���-� �C-��� �3�':�'�C'� ��.lr}�L"•J.;V' 4't; v,_ ��{ I.__ 1 , � "� :='C.:, /C) <br /> Relinquished By: (Signature} Received By: (Signature) Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> t <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> ,i { Transport Container Transported with this <br /> �--.1 Chain (by Serial No.)' <br /> Send Lab Results to (Name): -- = - — (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER OTHERIIJ, <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 <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 ENVIRONMENTAL SERVICES, CORP. • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 —FAX (303) 290 8013 <br /> SFRIAI.Nn WHITE:Field Copy - YELLOW:Project Coo, P[l K:I.ahoralory Cony REV.8192 <br />