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KAPREALIAN ENGINEERING 4+ <br /> I N C 0 R P 0 R A T E D <br /> CHAIN Or CUSTODY <br /> SAMPLER (XIC-7y SITE NAME d ADDRESS ANALYSES REQUESTED TURN AROUND TIME <br /> WITNESSING AGENCY � � � j j ,z �� �� 'z) c r <br /> NO. � ` <br /> --- OF <br /> SAMPLE OF SAMPLING ` ` R E N A R K S <br /> ID No DATE TIME SOIL WATER GRAB COMP CONI LOCATION <br /> 2 1/0/;z <br /> Reli shed by Signature) Date/time R cawed b Y(Sinat e) The following MUST BE completed by the laboratory accepting samples <br /> Sfor analysis <br /> + 1 Have all samples received for analysis been stored in ice? <br /> Relinquished by (Signature) Date/Time ceive by (Signature) <br /> 2 Will samples/ ema n refrigerated until analyzed? <br /> Relinquished by- (Signature) Date/Time Received by (Signature) 3 Did any sampteA re eived for analysis have head space? <br /> 4 Were sampl s oppropriate containers and properly packaged? <br /> Relinquished by. (Signature) Date/Time Received by (Signature) <br /> c kt - <br /> sIgnature T I t tov Date <br /> 2401 Vinwell 1)rwL,SMIL 4(X) <br /> (id(uorrl (Ailforriu 91520 <br /> TrI 510(0251(X) I ix 51400002 <br />