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CANONIE ENVIRONMENTAL%AIN-OF-CUSTODY RECORD W PROJECT ' <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME Gwrclwtr-.�roPts' SAMPLERS-F,;.4 �"� �+^ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> G L_ •b/�� R1NT1 DESCRIPTION CODES A Groundwater F oil <br /> PROJECT NUMBER f`1 lC� A 40-ml VOA Vial B Surface water o waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Splke 2 48 Hour <br /> RECORDER C Plastic 500-mi F Other D Rinseate 1 Other 3 24 Hour <br /> (SIGN) D Plaslto Liter E SolifSediment 4 Other <br /> NUMBER OF LYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND 1V <br /> p PRESERVMION g <br /> � — � �is � • SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID _' NUMBERS RECEIPT NOTES <br /> S z-1,01 <br /> 1"145 G►P L Lr - <br /> 11-12- SW �-•� r Q- <br /> I Q 167 G - Wyj I •0' t <br /> + VU 4, V, 10.0 �I <br /> NOTES I MISCELLANEOUS quashed by (Signature) Received By (Slgnat e) ate Time <br /> ��. a 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 /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ GALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER A OTHER <br /> TEL(214)770-1800 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219)926-8651 TEL <br /> FAX(214) 770 0249 FAX(303) 799-0186 FAX(714)757-0960 FAX(415)960-C 739 FAX (219)926 7169 FAX <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586 9496 TEL(713) 589-8686 TEL (215)337 2551 TEL(510) 463-9117 TEL(503) 241-0282 TEL j <br /> FAX(406)586-9724 FAX (713) 531-8886 FAX (215) 337-0560 FAX(510)463-2981 FAX (503)241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770-1800 • FAX (214) 770-0249 <br /> SERIAL NO 91 <br /> „ q R WHITE Field Copy YELLOW Prolett Copy PINK Laboratory Copy REV 11193 <br />