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PROJECT <br /> CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD ! <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME H01, SAMPLERS A 1.1P_9 FIC 9&= SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> � <br /> r JPRI DESCRIPTION CODES A Ground Water F Oil + <br /> PROJECT NUMBER 9`7 j U I ' Ca tcy-, 7tG A 40 ml VOA Vial B Surtace water G Waste 1 Standard <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rmseate I Other 3 24 Hour <br /> (SIGN) D Plastic Lfter E SoillSedimeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS U <br /> a' AND z ° m <br /> �— 8 <br /> PRESERVATION 0 n <br /> �8 x�S $` w <br /> 88 m m t� E¢ =r SAMPLE <br /> a� mr o" m� ad F m`-'48 NOTES ASSIGNED CONDITION <br /> E °v BOTTLE UPON <br /> DATE TIME SAMPLE ID y �' = NUMBERS RECEIPT NOTES <br /> Z qdays <br /> NOTES I MISCELLANEOUS Relinquished b (Signature) Itved By SI nature) Date Time <br /> 6%&f,9 40T) I'D 2� <br /> LAW SE-0001ARelinquished By (Sig re) ve By ( ignature) to 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 /> ah <br /> Send Lab Results to (Name) ICA Al IV (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ DALLAS ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER MDpE= <br /> TEL (214) 770-1800 TEL (303) 790-1747 TEL (714) 757 1755 TEL (415) 960-1640 TEL (219) 926 8651 TECH -W 9ZZ'L <br /> FAX (214) 770-0249 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415) 960 0739 FAX (219)926-7169 FAX 7 -ZZZ5` <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 • TWO GALLERIA TOWER • 13455 NOEL ROAD, SUITE 1500 • DALLAS TX 75240 • TELEPHONE (214) 770-1800 • FAX(214) 770 0249 <br /> nrrn�i +n UIHITF Flcirl f nn VFI I Priv Prep—t f nrni PINIK I rnrm RFV 11141 <br />