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CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORDPROJEC-W <br /> t `� (See Reverse V­ Instructions) NG <br /> Op <br /> PROJECT NAME, (�iS2 l ►"�II � ` SAMPLERS �`0M SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES if <br /> (P DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER lbw. �--�- A 40-ml VOA Vial B Surrace Water G waste 1 Standard <br /> SSI 8 Glass Liter E Brass Tube C Leachate H alanklSpke 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) ❑ Plastic Liter E SmIlSedlmant 4 Other <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> do. % <br /> o AND <br /> mms ng PRESERVARON 2 qJ S * R <br /> x <br /> x� gSAMPLE <br /> oTi� <br /> VO F= E ." ci NOTES ASSIGNED CONDITION <br /> a = v �� o BOTTLE UPON <br /> DATE TIME SAMPLE ID �' _ )— A _° NUMBERS RECEIPT NOTES <br /> -5 -O <br /> 33� - SAI- 3z O I I Vx xxI <br /> - sg' - 113. 0 KX <br /> d vo-ok X XX <br /> Z3 ZA- S 83- 30 o 1 X X <br /> 17- BP- 58-3 - <br /> �o r A-s8L1 s o >15 rx <br /> Wo- D- !;A-A - 30.0 x X r <br /> `I`ll -585- rS-a X X X <br /> 7 2- DA- S 6S -- 'NO p <br /> D <br /> NOTES 1 MISCELLANEOUS Q SR Qv,191p100 RelinC ( Ixos— <br /> ul hod b lure) R elved By (Signature) Dae Time <br /> to'g, <br /> ,PP l�. Mme,V.) - d�aSe-1 t v�nv��' 0,\ , �LkJ��- Relinquished B ( g I.ure) R ived By (Signature) D to Time <br /> y 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 ContainerTransported with this <br /> (� .rt Chain (by Serial No) <br /> t Send Lab Results to (Name) a�a✓♦� «�"`�� (Check Office B ow) Verbals Requested Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER " OTHER M�sJo <br /> TEL(404) 951-0055 TEL(303) 790.1747 TEL (714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL Z2 <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 FAr(503)2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWDO, , CO 80111 • TELEPHONE (303) 290-8336 • FAX (303) 290-8013 <br /> TRIAL NO WHITE Field Copy YELLOW Prolact Copy PINK Laboratory Copy REV 8192 <br /> 14683 - <br />