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CANONIE ENVIRONMENTAL CHAIN -OF -CUSTODY RECORD <br />,� (See Fjeverse for Instructions) 7q? 7,45-6 <br />LAB PROJECT <br />NO. '�? cS' Z <br />PROJECT NAME rR',JY'-� ltilk SAMPLER$ <br />PROJECT NUMBER t1 1 t?^ <br />4rY� <br />RECORDER <br />(SIGN) <br /># <br />SAMPLE CONTAINER <br />DESCRIPTION CODES <br />40 -ml VOA Vial <br />'. Glass Liter E. Brass Tube <br />C. Plastic 500 -ml F. Other <br />D. Plastic Liter <br />SAMPLE DESCRIPTION CODES <br />A. Ground water F. Oil <br />B. Surface Water G. Waste <br />C. Leachate H. Blank/Spike <br />D. Rinseate I. Other <br />E. Soil/Sediment <br />TAT CODES <br />t_ Standard <br />2. 48 Hour <br />3. 24 Hour <br />4. Other <br />DATE TIME <br />TEL (415) 573-8012 <br />SAMPLE IDn <br />TEL (407) 856-7428 <br />v <br />E-- <br />n— <br />° ° <br />E" <br />NUMBER OF <br />CONTAINERS <br />AND <br />PRESERVATION <br />oac? <br />= <br />LLz <br />LL <br />ANALYSIS <br />FAX <br />REQUESTED <br />❑ KING OF PRUSSIA <br />❑ HOUSTON <br />� <br />E E Q <br />� � <br />E <br />N <br />> <br />z <br />NOTES <br />LABORATORY USE ONLY <br />I':. <br />FAX (303) 799-0186 <br />FAX (215) 337-0560 <br />FAX (713) 556-0666 <br />FAX (415) 960-0739 <br />SAMPLE <br />ASSIGNED CONDITION <br />BOTTLE UPON <br />NUMBERS RECEIPT NOTES <br />.ajCQ <br />CA 95206 • TEL.(209) <br />piuA <br />f 714514 <br />NOTES! MISCELLANEOUS <br />)) <br />`1 ia�% <br />( <br />Relinquished by: (Signature)ei <br />Relinquished By: (Signature) <br />y: ('gn re ate <br />Received By: (atu <br />Si re Date <br />TIn <br />Time <br />Relinquished By: (Signature) <br />Received By: (Signature) Date <br />Time <br />M, <br />thodflat Shipment <br />Description of <br />Transport Container <br />Other Chains -Of -Custody <br />Transported with this <br />Chain (by Serial No.) <br />Dispatched By: <br />(Signature) Date <br />Time <br />Received for lab By: (Signature) Date <br />Time <br />C <br />Send Lab Results to (Name): !fie~ <br />1 Arte- 5 <br />(Check Office Below) rbals Re uested: Yes ❑ No ❑ <br />❑ PORTER <br />❑ SAN MATEO <br />❑ IRVINE <br />❑ ORLANDO <br />❑ OTHER <br />TEL (219) 926-8651 <br />TEL (415) 573-8012 <br />TEL (714) 757-1755 <br />TEL (407) 856-7428 <br />TEL <br />FAX (219) 926-7169 <br />FAX (415) 573-5654 <br />FAX (714) 757-0960 <br />FAX (407) 855-2595 <br />FAX <br />❑ DENVER <br />❑ KING OF PRUSSIA <br />❑ HOUSTON <br />❑ MT. VIEW <br />❑ OTHER <br />TEL (303) 790-1747 <br />TEL (215) 337-2551 <br />TEL (713) 556-1666 <br />TEL (415) 960-1640 <br />TEL <br />FAX (303) 799-0186 <br />FAX (215) 337-0560 <br />FAX (713) 556-0666 <br />FAX (415) 960-0739 <br />FAX <br />CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE, SUITE A • STOCKTON, <br />CA 95206 • TEL.(209) <br />983-1340 • FAX (209) 983-0304 <br />SERIAL NO. 42 <br />WHITE: Field Copy YELLOW: Project Copy PINK: Laboratory Copy <br />