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CANONIE ENVIRONMENTAL CHAIN -OF -CUSTODY RECORD LAB PROJECT <br />(Pee Reverse for Instructions) NO. <br />—IN'T) <br />PROJECT NUMBER <br />(SIGN) <br />RECORDER <br />(SIGN) <br />14 <br />SAMPLE CONTAINE9�� <br />DESCRIPTION CODES <br />I A. 40 -ml VOA Vial <br />S. Glass Liter E. Brass Tube <br />C. Plastic 500 -ml F. Other <br />D. Plastic Liter <br />SAMPLE DESCRIPTION CODES <br />A. Ground Water F. Oil <br />S. Surface Water 0. Waste <br />C. Leachate H. BlanklSplke <br />D. Rinseate I.,Other <br />E. Soil/Sediment <br />TAT CODES <br />1. Standard <br />2. 48 Hour <br />3. 24 Hour <br />4. Other <br />❑ PORTER <br />SAMPLE ID <br />• <br />• <br />❑ ORLANDO <br />El OTHER <br />TEL (219) 926-8651 <br />TEL (415) 573-8012 <br />TEL (714) 757-1755 <br />TEL (407) 856-7428 <br />TEL <br />FAX (219) 926-7169 <br />LABORATORY USE ONLY <br />SAMPLE <br />• ASSIGNE CONDITION <br />BOTTLE UPON <br />NUMBER <br />L <br />FAX (407) 855-2595 <br />FAX <br />IiINIMME111 <br />SEMEN <br />❑ HOUSTON <br />❑ MT. VIEW <br />❑ OTHER <br />TEL (303) 790-1747 <br />TEL (215) 337-2551 <br />TEL (713) 556-1666 <br />TEL (415) 960-1040 <br />I FA <br />0 <br />MIN NE 0010) W, �1� IN <br />FAX (713) 556-0666 <br />FAX (415) 960-0739 <br />FAX <br />CANONIE ENVIRONMENTAL LABORATORY 9 212 FRANK WEST CIRCLE, SUITE A a STOCKTON, CA 95206 e TEL. 209 983-1340 a FAX (kO9) 983-0304 <br />SERIAL NO.03440 <br />WHITE: Field Copy YELLOW: Project Copy <br />PINK: Laboratory Copy <br />ONE <br />DOMINION <br />EMISSION <br />NOTES/ MISCELLANEOUS <br />A4 WC, a-3 <br />T3.Dx X16 <br />04) e— <br />PO4��r C <br />Dp , r, -t <br />ASPnquished by: (Signature) <br />.14 <br />�'Rerin_quished By: (Signa <br />Relinquished By: (Signature) <br />-otthad By. fSkiban <br />Received By: (Signature) Date <br />Time <br />Method of Shipment <br />'Description o <br />Transport Container <br />VyRurv- ffff(W-*r-k-:.T19fTr,J <br />TransR <br />Chain (by Serial No.) <br />Dispatched By: (Si nature) Date <br />, —Time <br />Send Lab Results to (Name): <br />14 <br />r, <br />(Check Office -Bel - aw) _ V/bals <br />Re,5(uested: Yes ❑ No ❑ <br />❑ PORTER <br />❑ SAN MATEO <br />❑ IRVINE <br />❑ ORLANDO <br />El OTHER <br />TEL (219) 926-8651 <br />TEL (415) 573-8012 <br />TEL (714) 757-1755 <br />TEL (407) 856-7428 <br />TEL <br />FAX (219) 926-7169 <br />FAX (415) 573-5654 <br />FAX (714) 757-0960 <br />FAX (407) 855-2595 <br />FAX <br />❑ DENVER <br />❑ KING OF PRUSSIA <br />❑ HOUSTON <br />❑ MT. VIEW <br />❑ OTHER <br />TEL (303) 790-1747 <br />TEL (215) 337-2551 <br />TEL (713) 556-1666 <br />TEL (415) 960-1040 <br />TEL <br />FAX (303) 799-0186 <br />FAX (215) 337-0560 <br />FAX (713) 556-0666 <br />FAX (415) 960-0739 <br />FAX <br />CANONIE ENVIRONMENTAL LABORATORY 9 212 FRANK WEST CIRCLE, SUITE A a STOCKTON, CA 95206 e TEL. 209 983-1340 a FAX (kO9) 983-0304 <br />SERIAL NO.03440 <br />WHITE: Field Copy YELLOW: Project Copy <br />PINK: Laboratory Copy <br />I <br />0 <br />