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0 CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD . PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME ,_1 tfs SAMPLERS �)j r ! `,t SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> S 3 �� t (�,r �!I>1 S,t, DESCRIPTION CODES A Ground Water F Oa <br /> PROJECT NUMBER A 40-ml VOA Vial 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 Plastk%O-ml F Other D Rinseate I Other 3 24 Flour <br /> (SIGN) D Plastk Liter E Soll/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS �1 <br /> AND PRESERVATION <br /> k $ <br /> drLSAMPLE <br /> gli _ NOTES ASSIGNED CONDITION <br /> C f. <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID _ = NUMBERS RECEIPT NOTES <br /> s �• f I t, V,. <br /> NOTES!MISCELLANFQUS I' ellnqushed by (S nature) RB ved1B (1Stnatur� !Bate Time <br /> u Relinquished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method o"Shipment0esciription of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> nsport Container Transported with this <br /> � I <br /> Chain <br /> C�(11 e ra q I ri <br /> Send Lab Results to (Name) C,%`o, 3-7'""`�,_,,... .,.._ `, ` r (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL <br /> FAX(404)956.9364 FAX(303) 799-0186 FAX(714) 757-0960 FAX(415)960.0739 FAX(219)926-7169 FAX <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)241-0282 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 (303) 290-8336 - FAX 303 290-8013 <br /> SERIAL NO186 <br /> -18 <br /> WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV OX12 <br />