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QwKAPAEAUAN ENGINEEFtING, INC. <br /> CHAIN OF CUSTODY ' <br /> (SAMPLER I SITE NAME & ADDRESS <br /> C A' I ANALYSES REQUESTED I TURN ARCUND TIME: <br /> 754-17 C k- ' <br /> IIIITNESSlNL AGENCY ( I� <br /> I 1 a'1c �' �; <br /> 1 <br /> NO. <br /> I SAMPLE I ! II !I <br /> I ID Ntl, i I SOIL UATERII; OF SAMPLING <br /> DATE TIME E 11 A R i SRAB COMP CDNT.I LOCATION I <br /> f l <br /> S-�c e— <br /> V I I I I I f 1 <br /> ! <br /> I I <br /> I I I I I I I f ! ! ! I I 1 I [ I I <br /> f ! I I <br /> I <br /> 1 I I I I I I I f i i i I f I <br /> 1 i l l 1 1 1 1 i <br /> I f l l l ! f f I <br /> I <br /> 1Re'inqui hed by: (Signature) ! Date/lime Received <br /> I by: (Signature) I The following MUST BE <br /> [xhpleted by the laboratory accepting samples I <br /> for analysis: <br /> k[Retinquish (Signature) Have ■ll saeples received for analysis been stored in ice?I Date/Time I Received by: (Signature) I ! <br /> I I ! 12. Witt samples remain refri r ed ! <br /> 9e until analyzed? I <br /> (Relinquished by: (Signature) Date/Time J f <br /> f natI I Received by: (Signature) 13. Did any Swples received for analis have heads <br /> ! ! I NO pace.? <br /> IRelinquished by: (Signature) I I Received by: •(Signature) 14• <br /> Were samples in appropriate containers and Property ge, ! <br /> gnature) Date/Time y packs <br /> I <br /> Signature I <br /> li[le Datc I <br />