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CANONIE ENVIRONMENTAL 4NAIN-OF-CUSTODY RECORD <br /> 0113 PROJECT <br /> Q A (See Reverse for instructions) NO <br /> PROJECT NAME Sal •� Tic-1C�� SAMPLERS/�WTTN� J�'��"A SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 3 O y (P T) DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER A 40-ml VOA Vial a surface water G waste i Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H BlanktSpike 2 48 Hour <br /> RECORDER C Plastic SMml F Other D Rinseate I Other 3 24 Hour <br /> (SIGN) 0 Plashc Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> — § AND <br /> ae 5^ PRESERVATION $ � x <br /> a SAMPLE <br /> a ti NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID A � a � � � Z NUMBERS RECEIPT NOTES <br /> noft A <br /> 1 1333n•r a. A A t <br /> NOTES 1 MISCELLANEOUS ehnq shed bynature) c lved By (Si�gnature Date Time <br /> GQWMj- � �-07 .3-'Y10 <br /> 4.(] Relinquish By (Signature) Received By (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) Dale Time Received for lab By (Signature) Dale Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) T IL, 47: (Check Office Below) Verbals Requested Yes �❑l No �❑ <br /> LJ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER + +K"`_ .{ <br /> TEL (214) 770 1800 TEL (303) 790-1747 TEL(714)757 1755 TEL(415)960-1640 TEL(219) 926 8651 TEL r d T <br /> FAX (214) 770 0249 FAX (303) 799-0186 FAX (714)757-0960 FAX(415)960-C 739 FAX(219) 926 7169 FAX Za9. rJp-?s n 9 <br /> I <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406) 586 9496 TEL(713) 589 8686 TEL(215) 337 2551 TEL(510) 463-9117 TEL(503) 241-0282 TEL <br /> FAX (406) 586 9724 FAX (713) 5318886 FAX(215) 337 0560 FAX(510)463-2981 FAX (503) 241-0486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP a TWO GALLERIA TOWER a 13455 NOEL ROAD, SUITE 1500 a DALLAS, TX 75240 a TELEPHONE (214) 770-1800 a FAX(214) 770-0249 <br /> G17n1AI NO ! ? �I WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 15193 <br />