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CANONIE ENVIRONMENTAL ~MAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (� (See Reverse kor Instructions) <br /> PROJECT NAME _011I ., _ J _ _ SAMPLERS 3QYl �iid}1stt7Pi�__ SAMPI E CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 R] Tr DESCRIPTION CODES A G+o.rnd Water t O.. <br /> PROJECT NUM6ER I31e,.asae•� LT�tttG _ {� _ _ A 40 m1 VOA V+a] ti s�rlec•Wal., G weal. t Standard <br /> V <br /> ] N4�— e Glass Irlw E areas T.te C I*.Chat& r1 till kjspnke 7 W}loci. <br /> RECORDER_------ c Plast[WG mi F Olhei D Rrnsralo I Ulnar ] 24 11oul <br /> ISiGN1 D Plastic 01er _ E SowSedrment 4 other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS - - ---- -- -- `..--- <br /> AND <br /> aaa- �- PRESErTvutGN i <br /> �i T11 <br /> r I 6 NOTES ASSIGNED SAMPLE <br /> i I a CONDITION <br /> `- BOTTLE UPON <br /> DATE TIME SAMPLE ID CS $ NUMBERS RECEIPT NOTES <br /> 14P <br /> t r t � .�._—_. � b _ _ >: 1: >•_ _ ! _ � .� --- SSX�Lt fly--–r7 <br /> L-4,kL <br /> -Sys n2 <br /> NOTES/MISCELLANEOUS Re7u7`e7y-!81ur8) <br /> Received 13y (Signature) Dale Tlme <br /> elRecotvad By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) _ Date Tlme <br /> Method of Shipmoot Description of Other Chains Of Custody Dispatched By (Signature) Date Time Receivei B Slgnalur to Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> ASend Lab Results to (Name) *M r: , rl. ?110 _�,,�, L yl,y__� (Check Office Below) s egtlaste Yes ❑ No ❑ <br /> I7 PORTER ❑ SAN MATEO IRVINE L-1 OR ANDO 33 OTHER -�- <br /> TEL(219192&8651 TEL(415)573-8012 TEL(714) 757 1755 TEL(407)856 7428 TEL i�T_�3Zs'llZO <br /> FAX(2 19)8267169 FAX(415)573 5654 FAX(714)757 0960 FAX(407)855 2595 FAX(4jS)-__437=1 LlU DENVER ElKING OF PRUSSIA ❑ HOUSTON E] MT VIEW (_] OTHER _ <br /> TEL(303)7941747 TEL(215)337 2551 TEL(713)556 1666 TEL(415)960 1640 TEL _ <br /> FAX(303)799-0186 FAX(215)337-0560 FAX(713)5560666 FAX(415)960 0739 FAX <br /> CANONIE ENVIRONMENTAL LABORATORY • 212 FRANK WEST CIRCLE SUITE A • STOCKTON CA 95206 • TEL(209)983 1340 a FAX (109)983-0304 <br /> SERIAL NO 08116- - - --- - WHIIE F*U Copy YELLOW Project C.p]7y PINK Labwatary Cppy T� <br />