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M M = = M M <br /> CANONIE ENVIRONMENTAdE <br /> L MAIN-OF-CUSTODY RECORD PROJECT <br /> [ (See Reverse for Instructions) NO <br /> PROJECT NAME Ce I SAMPLERSr IMl C:r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 5N;} DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER A 40-ml VOA Vial 8 Surface Water G waste 1 Standard <br /> (SIGN) Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C plash 500 ml F Other 0 Rinseata I Other 3 24 Hour <br /> (SIGN) O Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS r� <br /> AND $_ + <br /> PRESERVATION <br /> d� LL9 SAMPLE <br /> o U r€ < NOTES ASSIGNED CONDITION <br /> $�° BOTTLE UPON <br /> Q,ATF TIME SAMPLE IDrV Io Z NUMBERS RECEIPT NOTES <br /> o� <br /> OLO <br /> A A .z <br /> /3-7-- . o <br /> -z- .s Y x ow <br /> - 3 O ok0s <br /> -3 ( O <br /> NOTES MISCELLANEOUS qulsh y ( pature) R eli(ed By Signat re} �, Date Ti e <br /> ].�, �T 4+�t �,a S fit+► t I �7� C�� _ ' ���', 0, <br /> GO Relinquished By (Signature) Recelved y (Signature) Date Time <br /> 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 Container Transported with this <br /> Chain (by Serial No <br /> eend <br /> a l r Coy�er 1 1�`,�5 -tic,,) l&2C) • r <br /> Lab Results to (Name) -'i' P (Check Office Below) Verbals Requested Yes No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER �QTHER ��S� <br /> TEL(404)951-0055 TEL(303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926 8651 TE — 2S <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)2410282 TEL <br /> FAX(406) 586-9724 FAX(713)556-0666 FAX(215)337-0560 FAX (510)453-2981 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 NO 1 [ 5 J 0 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />