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r r�r ■r r r � r r a■r. ■r �■�r r w =CANONIE ENVIRONMENTAL AIN-OF-CUSTODY RECORD <br /> +d rROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME r t Mk-0' q��4�� SAMPLERS �r ` ''Q SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRI DESCRIPTION CODES A Ground Water F Orr <br /> PROTECT NUMBER PA 40-mi VOA Vial B Surlace Water G waste 1 Standard <br /> (SIGN) B Grass Liter E Braga Tube C Leachate H Blank/Spike 2 48 Hour <br /> RECORDER C Plastic 500-mi fo L_?f0* D Rinseats I Other 3 24 Hour <br /> (SIGN) O Plastic Liter 1 E SorUSedlmeni 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS ' <br /> a II AD ~ <br /> PRESERVATION <br /> - J il Z �� € SAMPLE <br /> _ (/ �i NOTES ASSIGNED CONDITIONBOTTLE UPON <br /> ) <br /> DATE TIME SAMPLE ID �^ <br /> x u w UNUMBERS RECEIPT NOTES <br /> I ?Y/-5 VV4 rr <br /> ,a <br /> 17 Ln <br /> i <br /> NOTES 11P I SCELLANEOUS RehngwsIg Received By Signature) Date Time <br /> Cf <br /> @kOSitllSbBd 8>,r�.c,�Rala,rre) Received By ( t time <br /> Relinquished By (Sr nature _ Received Y ASgnasule,__ __ Date Time <br /> lul�t5hod of Shipment Description of Other Chains-Of Custody tchgd By Date Time kRece^ for4Reque4 <br /> D Time <br /> VV rens tt Container Transported with this r <br /> po Chain b Serial No f I c, 1 u P, <br /> GolL mate, --�--- -- �c5-�' gab Y44 <br /> Send Lab Results to (Name) t�� o)ir I b� (Check Office Below) VeYes ❑ No <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER ❑ OTHER <br /> TEL (404) 951-0055 TEL (303) 790-1747 TEL(714) 757-1755 TEL(415) 960-1640 TEL(219)926-8651 TEL <br /> FAX(404)956-9364 FAX(303) 799-0186 FAX (714) 757-0960 FAX(415)960-0739 FAX (219)926 7169 FAX <br /> 0 B02EMAN ❑ HOUSTON ❑ KING OF PRUSSIA �PLEASANTON ❑ PORTLAND ❑ OTHER---- <br /> TEL <br /> THER_, _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 I '^1 n I r F WHITE Field Copy YELLOW ProIetr Copy PINK Laboratory Copy REV 8/92 <br /> t <br />