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No we it rr on rrr M we so M r Mr <br /> CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD B PROJECT <br /> : /►'i 0.1— S'+� ASs�ss, y (See Reverse for Instructions) No <br /> PROJECT NAME SAMPLERS ' Atl1 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) �t DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER — A 40-mi VOA Vial �^ a surface water G Waste a(�Eandar7=' <br /> (SIG ) B Glass Liter E tltiGaTe,h- C Leachale H BlankJSpike 2 4E Hour <br /> RECORDER C Plastic 500 ml F Other D_1a1n6eale� I Other <br /> (SIGN) D Plastic Liter �J <br /> NUMBER OF ANALYSIS REQUESTED <br /> CONTAINERS LABORATORY USE ONLY <br /> AND ' <br /> a^ PRESERVATION B a <br /> SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE IDr ; ga 7. BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> 1 <br /> 7 r4 <br /> 1 <br /> z 214, J-1-1 <br /> NOTES 1 MISCE NEOUS elinquished by (Signature) Receive y SI atur Date Time <br /> 7� artE� $Or �' ' gCr"�Opiy <br /> - - 1 c <br /> y U 14Relinquished By (Slgnature) e w (Sig to `` e Ime <br /> t `' h�•/ foSt� S Cal)o/)i t✓ tai rOA v-Yl <br /> ,6et, '�.'1 - ! tm,4-(, /00 Relinquished By (Signature) Received By (Signature) Date Time <br /> V l <br /> Method of S fpm gf7T <br /> ription of her Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> rt Container Transported with this <br /> Chain(by Serial Nv) -(�m r ry <br /> -- line — <br /> Send Lab Results to (Name) ,.,/ (Check Office Below) Verbals Requested Yes �o ❑ <br /> ❑ PORTER PLEASANTON ❑ IRVINE ❑ A <br /> 9? TLANTA ❑ OTHER <br /> TEL(219)926 8651 TEL(415)463-9117 TEL(714)757-1755 TEL(404)951-0055 TEL <br /> FAX(219)926.7169 FAX(415)463-2981 FAX(714)757-0960 FAX (404)951-9364 FAX <br /> ❑ DENVER ❑ KING OF PRUSSIA ❑ HOUSTON ❑ MT VIEW ❑ OTHER <br /> TEL (303) 790-1747 TEL(215) 337-2551 TEL(713)556-1666 TEL(415)960.1640 TEL <br /> FAX(303) 799-0186 FAX(215)337-0560 FAX(713)556-0666 FAX(415)960.0739 FAX <br /> SERIAL NO <br /> CANONIE ENVIRONMENTAL SERVICES CORP 800 CANONIE DRIVE o PORTER, IN 46304 a TELEPHONE 219 92643651 ® FAX (219) 926-7169 <br /> WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy <br />