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�f <br /> KAPREALIAN ENGINEERING, INC. <br /> K <br /> CHAIN OF CUSTODY <br /> ISAMPLER ' I SITE NAME i ADDRESS I ANALYSES REQUESTED I TURN AROUND TIME: <br /> oc � o ,.. { <br /> 24 �rs . I <br /> 'WITNESSING AGENCY t <br /> I I f I 1 I I I No. I I tS I <br /> SAMPLE I I I I I I OF I SAMPLING { � I I I i I I I R E M A K S I <br /> I ID NO. I DATE I TIME SOI IWATERIGRAB COMP CONT.( LOCATION <br /> 1Cowtn.tgl� ��qal I ✓ 1 I I � I S I S'1t�dck �il� I J I I I I I I I I <br /> F + I <br /> � I � l 1 1,1 i 2 1 „ I ✓ I ! I { I I l I <br /> J 1 I I I I 1 I I <br /> I <br /> 2 l �, I J I I I I I I I I <br /> I <br /> I ., 231 ,� 1 I J 1 I IJ121 �� I ✓ I f I I I I 1 I <br /> I <br /> 50I J <br /> I <br /> k 1 f I I i l I l I I I I I I I I I <br /> I <br /> I I I I i I I I C f i I I I I I I <br /> IReJ i ed by: (Signature) I Date/Time I Received by: (Signature) The following MUST BE completed by the laboratory accepting samples 1 <br /> r�y/Qe I <br /> for analysis: i <br /> r 1. Have all samples received for analysis been stored in ice? I <br /> IRetinquis by: (Signature) I Date/Time I Received by: (Signature) 1 I <br /> I I I 2. Vitt saeptes remsi 'refrigerated until anatyzed? f <br /> I <br /> (Relinquished by: (Signature) I Date/Time f Received by: (Signature) 13. Did any saweples rec ived for analysis have head space? <br /> I I I 1 hJ f. <br /> 4. were samples in approrpriate containers and property packaged? I <br /> IRetinq.wished by: (Signature) I Date/Time I Received by: •(Signature) 1 I <br /> lqo I ; I <br /> Signature 'Title Datc I <br />