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KAPREALIAN ENGINEEI iMG, IMC. <br /> c1iAIH OF CUSTODY <br /> (SAMPLER l 1 \ ! SITE MAKE 1 ADDRESS i AKALVSES REOLEStED i TURN AR"D TIME: 1 <br /> I -Q -I- <br /> GO I ) <br /> I-COI ) — L© DI <br /> !WIIMESSIMC AUEMCY <br /> I ��'�' � C . �e�����£wtR•.' I,�L� � {��j.�i I°�,,,I Vl�,xJ,l�f vl <br /> �lj I <br /> NO. I I �,L1 ..I va U1- d I�Q <br /> I <br /> SAMPLE I I I I I ! I oT l SAMPLING ).j #ui t [ W A R it s i <br /> I ID NO. I DATE i TTHE I SOIL JUATER1 90 ICOMP I M"T LDC1lTlOM <br /> r------rbc �t tz t t f mew c l I i I L/! i i <br /> 1 I ('�}- 1 9 i! i ✓I i l/ ! i I I PPOAU ✓ ✓ ✓ �0 q� CQ cL�,P �`°I <br /> ! �?`� I/fir i i i L/I I ✓I I I I ,�i c/ 1 .�I ✓ . i 1 I '��t£_ v-e 5 IkS LAS i <br /> I <br /> 3.IC, <br /> i t/ I ,�I �! ✓i ! I ! <br /> yi P1 li r I ✓I i A i I ! i/I c/i✓ ✓! <br /> I <br /> � 48i� 9i i i c/ I I t✓I ! ` I i t�i✓ I✓ I LA I <br /> I <br /> LA I <br /> "� I l l C� I���c 921 l �/ I l ✓1 i � I i t/l ✓I ✓1 l/I I CCt'2 I � <br /> I LA ! ✓I I l I f/i t/ I✓I v! I i���—_�`` I <br /> I t, `2091 ! [✓I I ✓I I � iWaS�E�i��P,�eTce,�,�� I i/I { i ✓f Iji �� ! <br /> i The foltowing HIST RE comptated by the to ratory accepting sanples ! <br /> iR E nquis ed isnatura) �7Da a/Ti I olved b/: (Si turg] � I <br /> t '_ �. for analysis: <br /> 1. Haw sit scruples received (or lysis been stored In ice? i <br /> IRetinquished by: (Signature) I Date/Time I ived by: (iignatura) i I <br /> I I ! 2. Will swpies rermin refrigerate until anaty:ed? <br /> IRelinquished by: (Signature) I Date/Time I Received by: (Signature) �— 3. old any samples received for ice <br /> Is have head space? ! <br /> ! I I A, we samples In appropriate contsl(ers and property kaped7 I <br /> IRelin*dshed by: (SignetWO) I Date/Time I Received by. (Signature) 6// <br /> i i I ture Titte Onto ! <br /> I <br />