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S <br /> CANONIE ENVIRONMENTAL *AIN-OF-CUSTODY RECORD <br /> B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 4g2 A Le 12 :PA D,_YJ'L�� SAMPLERSSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ( RIN �� / DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBE=R !R Q UO 0 4 , �.�Gh+�J2J�tJ A 41)ml VOA Vial B Surface Water G Waste 1 Standard <br /> (SIGNI B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-ml F~Olher D R1nSeate I Olher 3 24 Hour ` <br /> (SIGN) D Plastic Liter E Soll/Sediment 4 Other <br /> NUMBER OF ANALYSIS REGI ESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> c `s AND 8^ + 8 <br /> gg a^ PRESERVATION S <br /> SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> e i <br /> LlV W > BOTTLE UPON <br /> DATE TIME SAMPLE ID a NUMBERS RECEIPT NOTES <br /> KAI 11 "A <br /> iz <br /> I <br /> I <br /> NOTES 1 MISCELLANEOUS Relinquished by (Signature) Received By (Signature) Date Time <br /> A v L40 iO G z�q� b <br /> Relinquished By (Signature) Received (Sign urs) 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 /> t <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER WOTHER <br /> TEL (404) 9510055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219) 926-8651 TE - <br /> FAX (404)956-9364 FAX (303) 799-0186 FAX(714) 757-0960 FAX(415) 960-0739 FAX(219)926-7169 F <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406)586.9496 TEL(713)5561666 TEL(215) 337-2551 TEL(510)463 9117 TEL(503) 2410282 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 /> SERIAL NO. 14547 WHITE f=ield Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />