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CANONIE ENVIRONMENTAL fDAIN-OF-CUSTODY RECORD ap PROJECT <br /> (� �1 �} <br /> (See Reverse fo Instructions) NO <br /> PROJECT NAME vl,Y`+r`�'� P�� }�I SAMPLERS_�X'4yJ +�O-', { �"l <br /> '1 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> r�yw _ E (PRltup) !1 DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER bo <br /> ` ,0,4~- R A 4D ml VOA Via$ B Surface Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Ririseale 1 Other 3 24 Hour <br /> (SIGN) D Plastic Liter E Sod/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> U <br /> i AND <br /> a s kz n^ PRESERVATION m a <br /> SAMPLE <br /> a <br /> el <br /> z° m° ¢ m°�U NOTES ASSIGNED CONDITION <br /> e° — _ E �— BOTTLE UPON <br /> DATE TIME SAMPLE ID y y z NUMBERS RECEIPT NOTES <br /> 11141,11 cm <br /> cf'40 fr-1 , <br /> U`f{5 <br /> (395 G- <br /> i'l lT-ZS <br /> _ Ic55 (,---L — <br /> NOTES/MISCELLANEOUS Re11nq (shed by (SI nature) Received By (Signature) Date Time <br /> �-J �v� ,2j-V- <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 /> �y Transport Container Transported with this <br /> f� V� Chain (by Serial No) <br /> Send Lab Results to (Name) rc,.,V\ (Check Office Below) Verbals Requested Yes ❑ Nov <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER S�' OTHER !U11: Ok, <br /> TEL(404) 951 0055 TEL(303)790 1747 TEL(714) 757 1755 TEL(415) 960 1640 TEL (219)926 8651 TEL 2.0 57Yf`tZL t <br /> FAX (404)956 9364 FAX (303)799 0186 FAX (714) 757 0960 FAX (415) 960 0739 FAX (219) 926 7169 FAX'L..1 57T`2 ZZ�- <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 5B6 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 A r+ I' WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 9192 <br /> /� 1 <br />