Laserfiche WebLink
i <br /> ! • i <br /> K KAFREALIAN ENGINEERING* INC. <br /> CHAIN OF CUSTODY <br /> Ir I I TUapwAau+D T/1ME:SAPPLER SITE NAME R ADDRESS I <br /> 1 WI 1 I f I I I I <br /> IWITNESSING AGENCY I (,0/ ,VGt�/t°►u�+? ��. I f I f I I I I <br /> I I 1 I I I I NO, <br /> I sAl�le I I 1 I I I I OF SAMPLING 1 E K A N K S 1 <br /> I ID NO. I DATE I TIME I SOIL JUATERIGRABICOMPICONT.I ' LOCATION I I I I I I 1 f <br /> '44 '111 1 91 I I 1 t/I 1 1 Se me seD #` I <br /> I � _ �o ,, I I ✓ I I S I I r } 1 � 1 I I I I I I � '�-� � <br /> _( zsl 1 1 1 ✓I - I �!I I I I l I I 1 ��� 1 <br /> ,,10 ✓ ! ! ✓! I I I I I 1 I I I 3 y <br /> I, },g-Nil <br /> 1 <br /> I y I I I I I i I I I I I I I I 7-JAI <br /> w6- 55I I I v l ISI I ! Irit i f I I I I � � <br /> I I <br /> IRe[i fished by: (Si atur ) I Dete/T me I Rece' by: (S tur The following MUST BE completed by the laboratory accepting sarvles I <br /> / / for analysis: <br /> I �/ w I 1 1. Have all seaple received for analysis been stored in ice? I <br /> IRetinquished by: (Signature) I Date/Time I Receis .d by: (Signature) I I <br /> I I I 1 z• Vitt swvtts r refrigerated until analyzed? I <br /> (Relinquished by: (Signature) I Date/Time I Rece;:. : by: (Signature) 13. Did any senpl received for analysis have head space? I <br /> A. were smples in a ropriate containers and properly packagedl <br /> (Relinquished by: (Signature) I Date/Time I Aecei.:1 by: (Signature) I 1 <br /> 1 I 1 1 <br /> I I I 1 ignature itle Dale I <br />