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0 CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD & PROJ5CT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME (370'0Y 'TL� ` -—0-1— SAMPLERS A' �Jycto A`uo SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> �L� ' ! 1 `PR' t _ DESCRIPTION CODES A Ground water IF OII <br /> PROJECT NUMBER <br /> �!, A 4D ml VOA Vial B Surlace Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSplke 2 40 Hour <br /> RECORDER C Plastic 500 ml F Other D Hmseale I Other 3 24 Haw <br /> (SIGN) U Plastic Liter E SOIIlSedlment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED <br /> CONTAINERS LABORATORY USE ONLY <br /> o AND m <br /> m e <br /> o 4i PRESERVATION 9 am a <br /> 38 88 m� og E ¢ 8� <br /> m_ ms o a5 E ,. _� SAMPLE <br /> z -Qu NOTES ASSIGNED CONDITION <br /> N = a �- m BOTTLE UPON <br /> DATE TIME SAMPLE Ip NUMBERS RECEIPT NOTES <br /> 31M it CP 35 G- <br /> U°LIL (,V <br /> L"- <br /> LL <br /> E <br /> U3C. �-IZ V <br /> I <br /> I <br /> I <br /> NOTES l MISCELLANEOUS Re1liJnquished b�l(Signature) Rece ed By (Signature) Date Time <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 tab By (Signature) Date Time <br /> Transport Container Transported with this <br /> 1 Chain (by Serial No) <br /> Send Lab Results to (Name) 'n ✓-0y (Check Office Below) Verbals Requested Yes ❑ No� <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER&,-WTEL (404) 951 D055 TEL (303) 790 1747 TEL (714) 757 1755 TEL (415) 960 1640 TEL (219) 926 6651 TEL JET 5_} `ZZ�f <br /> FAX (404) 956 9364 FAX (303) 799 0166 FAX(714) 757 0960 FAX(415) 960 0739 FAX (219) 926 7169 FAX 'U`It S-Pf`Z-t t 5' <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) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP + 6300 SOUTH SYRACUSE WAY, SUITE 300 + ENGLEWOOD, CO 80111 + TELEPHONE 1303) 290 8336 + FAX (303) 290 8013 <br /> SERIAL NO q r} �i WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 8192 <br />