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r � <br /> CANONIE ENVIRONMENTAL UHAIN-OF-CUSTODY RECORD SLAB PROJECT <br /> (See Reverse for Instrilicctlons) NO Y � <br /> PROJECT NAME T�rt� T��� SAMPLERS— '4t X SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> n /J (PRINT) r"' DESCRIPTION CODES A Ground Wafer F Oil <br /> PROJECT NUMBER �7 � � ��"" �� rf Q, s -&,.. L A. 40 ml VOA Vial B Surface Water G Waste i Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 4B Hour <br /> RECORDER C Plastic 500-ml F Other D nmseate i O3h4ar 3 24 Hour <br /> (SIGN) D Plastic Liter E Soill$ediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> u <br /> AND <br /> m B PRESERVATION 2 jg = mY a <br /> 3° d" 8 S a1 �! 2 a€ 9L SAMPLE <br /> as e Z m lU a m a°o" NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID LL ~ BOTTLE UPON <br /> +; NUMBERS RECEIPT NOTES <br /> NO 99 U2W- e fH <br /> 0*22 t �/ z <br /> r L 1S <br /> b <br /> I <br /> NOTES I MISCELLANEOUS ellnqulsft by (Slgnatur ) Received B (Signature) Date Time <br /> LAB�y <br /> L1t�v d I i} <br /> Reling <br /> ulshed By Ignature) Received By (Signature) Date Time <br /> V <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Rec f r ab By (Signature) Date Time <br /> y Transport Container Transported with this <br /> ` <br /> &M C K Chain (by Serial No) <br /> QAAlok <br /> • <br /> Send Lab Results to (Name) MIMse y (Check Office Below Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE f` w ❑ MT VIEW ❑ PORTER OTHER � U <br /> TEL(404)951-0055 TEL(303) 7901747 TEL (714) 7571755 "" ^-�.__ EL(415) 9601640 TEL(219) 926 8651 TEL eT <br /> FAX (404)956-9364 FAX (303) 799 0186 FAX (714) 757-0960 FAX(415) 960 0739 ` FAX(219)926 7169 FAX%02-57 1 <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH NRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80i11 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO w �I WHITE Field Copy YELLOW Project Gidiil_—yIT1K~Laboratory Copy '+� REV 8142 <br /> -I 1 - <br />