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KAiPR EALIAN ENGINEERING, INC. <br /> CHAIN or CUSTODY <br /> ANALYSES REM I TURN AR"D TIME: <br /> jsAMPLER I <br /> SITE NAME Z ADDRESS I <br /> f I <br /> CGS rb (� Un <br /> C�. I I I I I I <br /> lwllWESSING AGENCY <br /> j I Ivy <br /> I I I I I I I � FIIIA9 I <br /> No. j I l <br /> I I I I I I I OF I SAMPLING II I I I I I I <br /> 10 WD. I GATE j TIKEj salt jwrERjr�iAajcatvlcoNr.j LOUTION I � I (�l I <br /> i 1 ✓'i <br /> L1 <br /> i✓l` <br /> L1 I /f! I f r I ✓I . l I 1 I ! i <br /> l I l <br /> � l i k l l l l l I <br /> i i I 1 l 1 I I I I <br /> I I I I l I l I I I <br /> I ! 1 1 I I I I I _ <br /> I l l l l l l l ! <br /> I I 1 1 4 ! ! I i 1 I I I I <br /> I I I 1 <br /> I I I I i l I I 1 <br /> f R el ( ignatural t � The following MIST 8E caeP(eted try the laboratory Accepting ea,,plea <br /> Illelirgjiched by: (Signature) 1 Date/Time ls: <br /> I, Mew all temples received for a <br /> for rrulysrolysia been stored in ice? I <br /> � L � I <br /> Date/Time I Received by*. (SingAtura) <br /> 1Relira;uished by: (Sigrtstura) j 2. Will sanrptec rt+min refrigerated intll artatyxad7 <br /> I j I c <br /> S, Did &W sa�Plas received for "lysis have head spate? <br /> IRelirgjishad by: (Signatwe) I <br /> Date/Time I Received b/: (SigmturO i U <br /> ! i. were les In appropriate containers and properly paekege� <br /> (Signature) I Date/Time I Received b/: (Signature) <br /> �Qeli�ished W: (Signa I Date I <br /> I I ' Signature Litt ^� <br /> I I <br />