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CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> �7 <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 6A�2J)AR, P9WP_C;F__ T1I SAMPLERS �l1�X T'LO2 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> I �[ (PRINT)y� DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER —i� ��� - �� �� / • A 40-ml VOA Viet B Surface Water G Waste i Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Btank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-ml F Other D Amseate I Other 3 24 Hour <br /> (SIGN) <br /> V Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND $— <br /> g—�— PRESERVATION _ �$ $Y$Y <br /> 2. 8 . <br /> SAMPLE <br /> s < NOTES ASSIGNED CONDITION <br /> E ° BOTTLE UPON <br /> DATE TIME SAMPLE IDvv Y NUMBERS RECEIPT NOTES <br /> �Z <br /> MW <br /> .3 V <br /> J . <br /> ND W- LZfJ <br /> zt ►d A �. <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) Received By (Sign ture) Date Time <br /> LNe. ; � �� � t;zsg7 6 � <br /> Relinquished By (Signature) Received By (Signature) Date Time <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 /> nn I <br /> Send Lab Results to (Name) I rriirm 0. (Check Office Below) Verbals Requested Yes A�❑ No El <br /> lATLANTA El DENVER El IRVINE El MT VIEW ❑ PORTER OTHER Mn <br /> /065770 <br /> TEL(404) 951-0055 TEL (303) 790-1747 TEL (714) 757 1755 TEL(415)960-1640 TEL(219) 926 8651 TEL <br /> FAX (404) 956 9364 FAX (303) 799-0186 FAX (714)757 0960 FAX(415) 960-0739 FAX (219)926-7169 FA <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 (40,61=586 9724 FAX(713) 556-0666 FAX(215) 337 0560 FAX(510) 463 2981 FAX(503) 241-0486 FAX <br /> CANONIE IRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, 300 • ENGLEWOOD, CO 80111 • TELEPHONE (303) 290-8336 • F 03) 290 8013 <br /> SERIAL NO n C; n 7 WHITE Field Copy YELL elect Copy PINK Laboratory Copy REV 6792 <br />