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s CANONfE ENViRONMENTAI_ fAIN-OFi-CUSTODY RECORD4rBROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME SAMPLERSrM %t�eKw� ,� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P NT) DESCRIPTION CODES A Ground Water F Oil <br /> PR011=C7 NUMBER — A 40-ml VOA Vial B Surface Water G Waste f Standard <br /> (51 B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 How <br /> RECORDER��.,.��, C Plastic500-mi F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SolitSediment 4 Other <br /> NUMBER OF NALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND S g <br /> PRESERVATION $_ 17 yd 7 <br /> $ $ SAMPLE <br /> Em av LL -S -� i� aU`off NOTES ASSIGNED CONDITION <br /> > BOTTLE UPON <br /> DATE TIME SAMPLE ID Z NUMBERS RECEIPT <br /> = NOTES <br /> gl - ids fat <br /> 10 R - sbf - s <br /> I - <br /> - S Z- .�.� <br /> sgt <br /> Sa Z- ( 114 .S <br /> -Z <br /> �� - 5 <br /> 2. �p-s 3 - a S29 55' <br /> zo P -s 3 - 5 <br /> 0 1 6 L -s R3,3 - <br /> � 11 <br /> X <br /> NOTES!MISCELLANEOUS Reil gwshed by (Signature) Ived By gnature) Date Ttme <br /> Cit � U Ids �5~ G� MIaL� �� �8 7✓�_` —7 Z9517 <br /> J M18 <br /> r Relinquished By (Signature) Received By (Sign ure) Date -rime <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> o d � k - c�.p S,q.t ++(.ta�.� a 1 Q t1 ll�rOSs>; ^x- <br /> Method of Shipment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> L Transport Container Transported with this <br /> Chain (by Serial No) <br /> ' Send Lab Results to (Name) c�.a i <br /> ( } 11 ... <br /> (Check Office Below) Verbals Requested Yes ❑ No <br /> Sm•}h `t�c1 t <br /> El ATLANTA ❑ DENVER El IRVINE ❑ MT VIEW ❑ PORTER � OTHER rncO�sTQ,C4 <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 ' n <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER r <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 + TELEPHONE k303) 290-8336 • FAX 303) 290-8013 <br /> SERIAL NO 14681 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />