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16 CANONIE ENVIRONMENTAL MAIN-OF-CUSTODY RECORD orPHOJE'CT <br /> (See Reverse nstructions) NO <br /> PROJECT NAME ( Y`�r 4 +l''S)1' ) SAMPLERS f illi+,,i 1}111, SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) 1 DESCRIPTION CODES A Ground Water F Opt <br /> PROJECT NUMBER j 1 L I �tU `/r,- !j It A 40 mlVOA Vial a Sudace Water G Waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Plastic 500 ml F Other D Rmseale I Other 3 24 Hour <br /> (SIGN) D Plastic Liter _ E Sal/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS p <br /> o AND ♦ c °a <br /> wm �i PRESERVATION g_ jr W <br /> SAMPLE <br /> o o1 �m EL mUa� NOTES ASSIGNED CONDITION <br /> E� E° n = LLv t E o BOTTLE UPON <br /> DATE TIME SAMPLE ID N Z NUMBERS RECEIPT NOTES <br /> r�I� ray i 'a !� <br /> (i,1{ r� Lri♦ <br /> J, �f <br /> —1-1:1 F m_ :_F <br /> NOTES 1 MISCELLANEOUS Relinq ished by (Signature) Reoeived By (Signature) Date Time <br /> � r 1 <br /> Relinquished By (Sigrtalure) 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 /> �y Transport Container Transported with this <br /> Chain (by Serial No) <br /> r+ 1t� a + <br /> It,%,,Lor I(rtn1111"11, 1t, I4 <br /> Send Lab ResUlts to (Name) I r 141% , lip_ (Check Office Below) Verbals Requested Yes ❑ No.k, <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ♦® OTHER AAIQtlk <br /> TEL (404)9510055 TEL (303) 790 1747 TEL(714) 757 1755 TEL (415) 960 1640 TEL (219) 926 8651 TEL jCiT1 - 1 Z r 1 <br /> FAX (404) 956 9364 FAX (303) 799 0186 FAX (714) 757 0960 FAX (415)960 0739 FAX (219) 926 7169 FAX V)1 571 it,2 7 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA ❑ PLEASANION ❑ PORrLAND ❑ OTHER <br /> TEL(406) 586 9496 TEL (713) 556 1666 TEL (215) 337 2551 TEL (510) 463 9117 TEL(503) 2410282 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 WHITE Field Copy YELLOW Project Gopy PINK Laboratory Copy REV 8192 <br />