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PROJECT <br /> CANONIE ENVIRONMENTAL *AIN-OF-CUSTODY RECORD <br /> (See Reverse fo Instruchons) NO <br /> PROJECT NAME ; i 1 {St[ D r I I+oyo j )i I SAMPLERS I 02 Miff ! f( (`1 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI 1) !j G DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER i_?4 2- ` lit,"11 4 A 40 ml VOA Vral B Surlace Water G Waste t Standard <br /> {SIGN) 8 Gtass Liter E Brass Tube C Leachate It Blank/Spike 2 48 Hour <br /> RECORDER C Plasuc 500 ml F 01her D nmseate I Other 3 24 Hour <br /> (SIGN) D Plasllc Liter E SodlSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> e AND n c <br /> PRESERVATION $Y � ?S 6 $ <br /> `g � ou E <br /> 8 0. Ut Nz =r SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> E ° BOTTLE UPON <br /> DATE TIME SAMPLE 1D y (j N z NUMBERS RECEIPT NOTES <br /> Lob7 r", �- I <br /> t� II! G ) <br /> r <br /> 1 F <br /> r <br /> , <br /> T) <br /> ( t <br /> NOTES 1 MISCELLANEOUS Reltpqutshned b (Signature) Received By (Signature) Date T1me <br /> —�jr (Atj <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 /> 1 Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) 1,�_cy-,_ L ) , (Check Office Below) Verbals Requested Yes ❑ No 'Q <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER DQ'OTHER M,.A) } It; <br /> TEL (404) 951 0055 TEL (303) 790 1747 TEL (714) 757 1755 TEL(415) 960 1640 TEL (219) 926 8651 TEL 7(37 i 11 L2 }) <br /> FAX (404) 956 9364 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415) 960 0739 FAX (219)926 7169 FAX L`i i 1 1 L i t <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) 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 11303) 290 8336 • FAX (303) 290 8013 <br /> SERIAL NO ,� „ WHITE F1eld Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br /> s i <br />