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� CANONIE ENVIRONMENTAL&AIN-OF-CUSTODY RECORD `B PROJECY <br /> (See Reverse <br /> Reverse for Instructions) NO <br /> PROJECT NAME � � 7FR9` � SAMPLERS OTLEX "Qp c" SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ��$� 0001 .�. oR�-�� DESCRIPTION CODES A Ground Water P oil <br /> PROJECT NUMBER !f �' A 40-ml VOA Vial B Surface water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> t C Plastic 500-mi F Other D Rinseate I Other 3 24 Hour <br /> RECORDER 0 Plastic Liter E Soil/Sediment 4 Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o Y <br /> c AND <br /> m&a8 PRESERVATION 6a S � Y <br /> SAMPLE <br /> gym . S do m E m"aU NOTES ASSIGNED CONDITION <br /> Em E °r BOTTLE UPON <br /> DATE TIME SAMPLE ID �' = N z NUMBERS RECEIPT NOTES <br /> Icy U W) - A r>L <br /> .Z <br /> c Ibt' 3 <br /> S mva- t <br /> til i R 3 t tf <br /> �ygq� vNt ��L A L n <br /> I� ars !rt <br /> Y C1 <br /> N <br /> NOTES 1 MISCELLANEOUS ..���,�.;- Relinquished by (Signature) Received By (Sig ature) �� Date Time <br /> 4`►�� "lE � C'�~�.�L�t3LE` 1 �.[y c�C rf � <br /> 'rte � Q IL-" Relinquished By (Signature) Received By (Signature) Date Time <br /> I <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shl ment Description of Other Chains Of Custody Dispatched By (Sig-rid ) Date Ttme Received for lab By (Signature) Date Time <br /> U Transport Container Transported with this <br /> � Chain (by genal No) <br /> L00a t � Q— dL t'e <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ❑ OTHER <br /> TEL(404)9510055 TEL (303)790-1747 TEL (714) 757-1755 TEL(415)9601640 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 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER— <br /> TEL <br /> THER 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 6013 <br /> SERIAL NO _l WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />