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KArREALIAN ENGINEERING, INC. <br /> MAIN OF CUSTODY <br /> 'SAMPLER I SITE MANE t ADDRESS I ANALYSES REOUESIED I TURN AROUND TIME: I <br /> ! (,� I ) ' Reg �a <br /> (Jnota� �ocl ! I ! I I 1 I ---� I <br /> iWITNESSIMG AGEW" I Gad�! Ke/&.*mrxn kn. I <br /> I i I I I I I I Mo• 1 ! `j;l �! � I I 1 I ! <br /> SAMPLE I I I I I ! I OF I SAMPLING II ( °I ! I I f E N 1i R k S i <br /> ID NO. I DATE i TIME I SOIL IWATERIGRABICOMPICONT.i LOCATION I OoI I I I <br /> I �! i I I ✓I I �) I ;. 1 � S ,6f I 1 ! ✓ I V U I I I l 1.Z.0�rj� I <br /> ! I I 1 I I I I I I I V1 ! VI ! k Ild ! <br /> 1 !/I <br /> ! <br /> vl <br /> ,� I I v l ! vl I f ! I vl V <br /> �a I L/I <br /> i <br /> I ! I ! I I I I I I I 4 I ! I ! I I <br /> f <br /> I 1 I I I I I I I I I ! I f I I I 1 <br /> .. I <br /> I I I I I I I I I I I I I ( f I I I <br /> ! <br /> i i I I I i l l I I I I I I I I I I <br /> IReli fished bat ( ignat e) I D tr Time ' Rece{ved by: (S' t ) I The following MUST BE completed by the laboratory accepting swV(es I <br /> ;r � <br /> for analysis: ! <br /> 1. Nave all samples receiv ar analysis been stored in ice?Or i <br /> Ittetinquithed by: (signature) I Date/Time Recs,red by: (Signature) I f <br /> 1 I 1 2. Witt saVles remain re rated until anatyzed? ' <br /> I <br /> ltelinquished by: (Signature) I Date/Time I Received by: (Signature) 3. Did ary samples received for &utysis have head %We? i <br /> I <br /> 4. Were samples in aper ate containers and properly packaged? i <br /> IRelinquished by: (Signature) i Date/Time I Received b , (Signature) !L 01I <br /> I ! I 1 <br /> I I I igneture Title Date ! <br /> r i � <br /> A <br />