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-TMM <br /> jCANONIE ENVIRONMENTALIWAIN-OF—CUSTODY RECORD 4r. PROJi=CT <br /> _ (See Reverse for Instructions) NO <br /> PROJECT NAME t Kbt km SAMPLERS mo qQ'^ 'Ak,t-n SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT COL11=S <br /> �-I INTI��D�102 DESCRIPTION CODES A [groundwater F Oil <br /> PROJECT NUMBER `rS �tr&P` A 40-ml VOA Vial B Surface Water G walla 1 Standard <br /> r� (SIGN) 8 Glass Liter E Brass Tube C Leschale H clank! Iko 2 48 Hour <br /> RECORDER ��4i`� V0.-17"� C Plastic5Wml F,ghft 0 Rineaala I Other r['r 9 24 Hour <br /> ISION) D Plastic Liter lSF]Ia-r E SolllSedlmeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERSANO <br /> 9 J 4 <br /> PRESERVATION _ <br /> e a SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> BOTTLE UPN <br /> DATE TIME SAMPLE ID <br /> ! v = ~ y NUMBERS RECQ PT NOTES <br /> MU 1115- i o f rAr <br /> I <br /> i <br /> NOTES 1 MISCELLANEOUS J RQllinquisl h� by (Signature) Received By (Signature) Date Time <br /> C <br /> SYh roti IAV. U N�.�-- <br /> ( Z{oQ GV i �r' Relinquished By (Signature) Received By (Signature) Date Time <br /> fjj,.5i.ID cA 0(-6351 <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of-Custody Dispatched By (Signature) Date Time Re "bS I tura) Date Time <br /> Transport Container Transported with this <br /> �t7dO�y r Oar `r- C 0 Chain(by Serial No) <br /> Send Lab Results to (Name) OSA 1$ How (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER .WOTHER maWo <br /> TEL(404)951-0055 TEL(303) 790.1747 TEL(714)757-1755 TEL(415) 960.1640 TEL(219) 926.8651 TEL ?El- S_i`1�u7 f <br /> FAX(404)956 9364 FAX(303)799-0186 FAX(714) 757-0960 FAX(415)980.0739 FAX (219)926-7169 FAX ISM 5a'1_2�'2S <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL(406)586 9496 TEL(713)556-1668 TEL(215)337-2551 TEL(510)463-9117 TEL(503)2410282 TEL <br /> FAX(406) 566 9724 FAX(713) 556-0666 FAX(215)337 0560 FAX(510) 463-2981 FAX(503)2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE (30)_290-8336 • FAX (303) 290 8013 <br /> SFnlAl TO <br />