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CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD Is pRaJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME ,� ALTL/ SAMPLERS 14 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER �y -3 3 01-10 r ( RI A W DESCRIPTION CODES A Ground Water F <br /> Q.��,, 40-m1 VOA Vial B Surface Wetar G Waste 1 Standard <br /> (SIGN) a Glass Liter E Brass Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 5MMI F Other D Rinseale I Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND $— Y <br /> �—g— PRESERVATION _ m <br /> E SAMPLE <br /> o �P $ o NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE 113 s �' `Y _- BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> Oyl 3:0 ffily,- I A A V Lr v <br /> !Z /�X.) Y)Pi i Y <br /> 1315 kIN -4 AA <br /> 12 131 J tc v r <br /> Al IU A A <br /> i <br /> NOTES!MISCELLANEOUS Relinquished by (Signature) R ceived By (Signal e) Date Time <br /> LSF: ��GI�� <br /> PICA-S& �or� ,��v�� , <br /> ak71I(�L?a��Uli U�'C1d� Relinquished B (Signature) Received B . e <br /> q y ( g } y ( gna ure) Dat 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 /> �4 Transport Container Transported with this <br /> �N-CcUn 1N Chain (by Serial No) <br /> 660uE,�P 'Ah'k &I/ft <br /> Send Lab Results to (Name) --f6+11VAA-1 n ::&U L Aird (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER "HER <br /> TEL(404) 9510055 TEL(303)7901747 TEL(714) 757-1755 TEL(415)960-1640 TEL(219) 926-8651 TEL ?-ZZ/ <br /> FAX(404)956.9364 FAX(303)799-0186 FAX(714) 757-0960 FAX(415)9604739 FAX(219) 926 7169 FAX�O�57g'ZZZS� <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 • FAX (303) 290-8013 <br /> SERIAL NO 15671 WHITE Field Copy YELLOW Prgoct Copy PINK Laboratory Copy REV 8192 <br />