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+� �r rr r r w r r �■�r rr jrBCANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORDPROJECT <br /> `---� � (See Reverse for Instructions) NO <br /> PROJECT NAME �d �� SAMPLERS t� 1140A+ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> }fo DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER A 40-mi VOA Vial B surface water G waste 1 Standard <br /> r <br /> M'.4,41 <br /> W� (SIGN) B Glass Llier 5 Brasa Tube C Leachate H BlankfSplke 2 48 Hour <br /> RECORDER (�y C Plastic 500-ml F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic I-der E SoilSedimenl 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> PRESERVATION 'S 1 <br /> S a gtEs 99 SAMPLE <br /> zdF! $ NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE IDV _ '` Z NUMBERS RECEIPT NOTES <br /> rr if:10 s— Y11 Ic <br /> lo i 7—60—lo 3 k I <br /> )< <br /> I , <br /> I <br /> NOTES/MISCELLANEOUSll`qul he by Signature} eived By (Signature) Date Time <br /> h �x a Ja-03-gG q, 5-6 <br /> Relinquished 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) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes No El <br /> ❑ ATLANTA El DENVER El IRVINE 1-1MTVIEW El PORTER IBJ OTHER <br /> TEL(404)951-0055 TEL (303)790.1747 TEL(714)757-1755 TEL(415)960-1640 TEL(219)926-8651 TE <br /> FAX (404)956-9364 FAX(303)799-0186 FAX(714)757-0960 FAX (415) 960-0739 FAX(219)926-7169 FA `Z2�S <br /> ❑ 13OZEMAN ❑ HOUSTON ❑ ICING 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 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 WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8199 <br />