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orl L � ENVIRONMENTAL AIN-OF-CUSTODY RECORD <br /> PROJECT <br /> (See Reverse for Instructions) R� _G NO 7 { <br /> PROJECT NAME C �RnOF t2 1�t2�VrV---T V SAMPLERS&EK 7 W l'Z-E S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Cp ! (PRIN DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 4�J92 DQ01 _b T A 40-ml VOA Vial B Surface Water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank[Spoke 2 48 Hour <br /> RECORDER S C Plastic 5DD-ml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) O Plastic liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> m <br /> `aa ag PRESERVATION <br /> Sm SY` m m ;€¢ at =� SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> y am LLv 4) �' f E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID _ — z NUMBERS RECEIPT NOTES <br /> t 1 1 <br /> 1104 V/1 I <br /> 5. 5' <br /> I"r.,5 7 <br /> II <br /> J55L 11 W <br /> } <br /> NOTES l MISCELLANEOUS Relinquished by (Signature) RWeiv d Byre) ate Time <br /> Relinquished By (Signature) eceived By Slgnatu Date Timid <br /> Relinquished By (Signature) Received By (Signature) Pate Time <br /> Method of hipment D caption of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> AE Cham (by Serial No) � <br /> f� r t 412 A,&-,L- <br /> Send <br /> Send Lab Results to (Name) ,-YVI (Check Office Below) Verbals Requested Yes ❑ No ❑C'�j) <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL (404)9510055 TEL(303) 790-1747 TEL(714)7571755 TEL (415)9601640 TEL(219) 926 8651 TEL 1 <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO 14743 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />