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LAB PROJECT' <br />NO <br />CANONIE ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD <br />(See Reverse for Instructions) <br />YELLOW: Project Copy PINK: Laboratory Copy REV '11193 WHITE: Field Copy <br />PROJECT NAME6AntAgC2- <br />PROJECT NUMBER <br />YR-0_ -VA-1- SAMPLERS _ ii.cLZ)4. -FLE) ILLS SAMPLE CONTAINER <br />DESCRIPTION <br />A 40-mi VOA Vial <br />B Glass Liter <br />C Plastic 500-ml <br />0 Plastic Liter <br />Brass <br />Other <br />CODES <br />Tube <br />SAMPLE DESCRIPTION <br />Ground Water <br />Surface Water <br />Leachate <br />O. Rinseate <br />E. Soil/Sediment <br />CODES <br />F. Oil <br />G. Waste <br />H. Blank/Spike <br />TAT CODES <br />Standard <br />48 Hour <br />24 Hour <br />Other <br />CI if - 32-C3 <br />)4"(;RINT....a. ja A) <br />RECORDER <br />(SIGN) <br />I. Other Ir._,•__N. t <br />(SIGN) <br />DATE TIME SAMPLE ID <br />t3 <br />p, <br />q <br />A - Sample Description (enter code) NUMBER OF <br />CONTAINERS <br />AND <br />PRESERVATION .7 <br />t_ - , <br />ANALYSIS REQUESTED TAT Requested (enter code) 1. 1 §?. 1,1 <br />o <br />:-%.1 § ii- <br />A <br />li <br />6_ <br />2 <br />NOTES <br />LABORATORY USE ONLY <br />if <br />A° <br />V /44, <br />t-- <br />' ASSIGNED <br />NUMBERS <br />SAMPLE <br />CONDITION <br />RECEIPT <br />• <br />NOTES <br />! <br />/ <br />t HNO, — ,...) <br />t 4 <br />3 V.I • ik '',. i/ / I .z.g bis)%/ ,./ <br />033fir 044o GP ‘‘.0.,-)-3 A• 1, 3 // I I/ i/ / <br />033:45' /1/450 GP rkw -4 fr A r 3 ../ / 1 v e ,, <br />'3lLt2.DGP Mv-) - 5 Pr ii, V3 // i V l V <br />4 vim GP Mo.) i, A V 3 /1 1 V , / <br />a ism I /b V/ i ./ ,/ s' <br />NOTES / MISCELLANEOUS <br />itc, 0 t.) <br />Rel n•Lilled by: (Signature) <br />>4 1-k-46 11.2.49-u...-J <br />Received By: (Signature) I Date <br />,_z."---. ( _5/3) 7 s— <br />Time <br />.r /-'04 <br />ime Relinquished By: (Signature) eceived By: (Signature) Date <br />Relinquished By: (Signature) Received By: (Signature) Date Time <br />Method of Shipment <br />..„,- AeG of.; <br />Description of <br />Transport Container <br />CooLe-fz. <br />Other Chains-Of-Custody <br />Transported with this <br />Chain (by Serial No.) <br />Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br />Send Lab Results to (Name): /Okk Linteg-4.4.Ani (Check Office Below) Verbals Requested: Yes LI No • <br />Li DALLAS <br />TEL (214) 770-1800 <br />FAX (214) 770-0249 <br />LII BOZEMAN <br />TEL (406) 586-9496 <br />FAX (406) 586-9724 <br />Ili DENVER <br />TEL (303) 790-1747 <br />FAX (303) 799-0186 <br />[11 HOUSTON <br />TEL (713) 589-8686 <br />FAX (713) 531-8886 <br />El IRVINE <br />TEL (714) 757-1755 <br />FAX (714) 757-0960 <br />El KING OF PRUSSIA <br />TEL (215) 337-2551 <br />FAX (215) 337-0560 <br />El MT. VIEW <br />TEL (415) 960-1640 <br />FAX (415) 960-0739 <br />III PORTER <br />TEL (219) 926-8651 <br />FAX (219) 926-7169 <br />1?(OTH ER .E9 c,.La rJ <br />TELZ0S/ 8.38'-3507 <br />FAX Z-01/ t 3 if-3509 <br />111 OTHER <br />TEL <br />FAX <br />LII PLEASANTON LI PORTLAND <br />TEL (510) 463-9117 TEL (503) 241-0282 <br />FAX (510) 463-2981 FAX (503) 241-0486 <br />CANONIE ENVIRONMENTAL <br />SERIAL NO <br />SERVICES, CORP • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS, TX 75240 • TELEPHONE (214) 770-1800 • FAX (214) 770-0249