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B PROJECT <br /> CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME SVQC-V-TbfJ 1Tll h1.%L- SAMPLERS ')C t S SAMPLE CONTAINER SAMPLE DESCRIPTION CODES 'TAT CODES <br /> r Z�y�t /� {PRINTF' DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER. _b_ I T- Q 100 Z— �A-�J1_+ T A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate H. Blank/Spike 2. 48 Hour <br /> RECORDER C. Plast{c 500-mi F.Other D Rinseate I. Other 3. 24 Hour <br /> (SIGN) D. Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS o <br /> m c AND e m <br /> PRESERVATION ms m mx u <br /> m 8 m SAMPLE <br /> 9 E =t <br /> C5 -� E m`-' Qo NOTES ASSIGNED CONDITION <br /> = �m E ° BOTTLE UPON <br /> DATE TIME SAMPLE ID N z NUMBERS RECEIPT NOTES <br /> �aozq A Z1 k4e' — <br /> �ooZ9� <br /> NOTES I MISCELLANEOUS Relinquished by: (Signature) Receivedn ureN� <br /> -- Date Time,- <br /> N ', �EQ�41 G(i. �1,(c f6 3 <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 `oUr2 <br /> Chain (by Serial No.) <br /> Co u�Q, N A <br /> Send Lab Results to (Name): -S (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER U40THER t U l <br /> TEL(404) 951-0055 TEL (303) 790-1747 TEL (714)757.1755 TEL (415) 960-1640 TEL (219) 926-8651 TE r✓"79 ZZM <br /> FAX(404) 956-9364 FAX (303) 799-0186 FAX (714) 757-0960 FAX (415)960.0739 FAX (219) 926-7169 FAX _0- <br /> ❑ BOZEMAN ❑ 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) 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 a FAX (303) 290-8013 <br /> SEWAL NO. 1 f l 1 1 WHITE:Fleld Copy YELLOW:Project Copy PINK:Laboratory Copy REV.W92 <br />