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r7r-f-1 r-ir r�n F-1, r-1. fl-I r-1, <br /> CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD 7PRoJEr T� <br /> (See Reverse for Instructions) NO. <br /> i <br /> PROJECT NAME G d SAMPLERS. (GCun SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> -3 "T) DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER /1 A. 4G-ml VOA Vial B. Surface water G. waste t. Standard <br /> 1 // I (SIGN) B. Glass Liter E. Brass Tube C.r C. Leachale H. BlanklSpike 2. 48 Hour " <br /> RECORDER t���/d_I I O. Plastic 506-mi F.Oth T�r�,�s" D. Rinseata I. Other 3. 24 Hour' ' <br /> (SIGN) O. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> g AND <br /> . S PRESERVATION <br /> ' z ?3a 4 z y _, SAMPLE <br /> $1 $i: _ � �� $ � NOTES ASSIGNED CONDITION <br /> J- s o BOTTLE UPON <br /> D TE TIME SAMPLE ID a = NUMBERS RECEIPT NOTES <br /> Z <br /> It—17 I j <br /> Z $ 2 <br /> NOTES l MISCELLANEOUS ` eli,qujghed b . (Signature) Rece'v By: (S' ur ate Time <br /> LJ <br /> O <br /> -- <br /> s #0PI ZONT�. 000fkt7 1/1 a Relinquished By: (Signature) : eceivB y: (Signature) Date Time <br /> �Jf' S Z-0-IN,- QlyRelinquished By: (Signature) Received By: (Signature Date <br /> 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 /> Fk Coo <br /> /�r Chain {by Serial No.} <br /> 111 <br /> -:960 <br /> Send Lab Results to (Name): 1 (Check Office Below) Verbals Requested: Yes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ ml VIEW ❑ PORTER OTHER �s <br /> fD <br /> TEL(404)951-0055 TEL(303)790-1747 TEL(714)757-1755 TEL(415) 960-1640 TEL(219)926-8651 TE - Z f <br /> FAX (404)956.9364 FAX(303)799.0186 FAX(714)757-0960 FAX(415)960-0739 FAX(219) 926-7169 FAX 72-57 <br /> ❑ B02EMAN ❑ 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) 241-0282 TEL <br /> FAX(406)566.9724 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. .I r rZ7 11 WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy REV.8192 <br />