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P - <br /> K KAPREALIAN ENGINEERING, INC. <br /> CHAIN OF cus,roDY <br /> ISAHPLER I SIZE NAME R ADDRESS ! <br /> ANALYSES REt}UESfEO I )llRN AROUND TIME: 'I <br /> I <br /> IuITNESSIkCAGENCT ! 6Q1 C ICe ��IawtG � l� I 1 f 1 1 ! I i <br /> R E M A R [ 5 <br /> SAMPLE I 1 I I// I ``I I OF I SAMPLING j <br /> ID NO. I DATE I TIME I soli IAhTE�` B7IC(7tPIcoNT.l LOCATIDu <br /> 1/1, <br /> o �I—i— ---T � �dh-S fess{ 3 I <br /> rN I ! v l J I f 21 >41 uJ I J ! I I �' <br /> 1I—I--f—i--f--I /i I ✓ 1 I I I � 1 I <br /> I mLo— I /� I I I ✓I ! l 21 I <br /> }—}— <br /> i---f—I—f--F— G <br /> I <br /> I--1---- I—I--!—�I I <br /> IRelirKpish t?y: (signature) I Date/time Received b/: ( tUre) I The following MUST 6E completed by the laboratory accepting samples I <br /> for analysis: f <br /> f`.. 1. Have atl smples received for analysis been stored in ice? I <br /> IReIirq,ished by r• (Signature) Date/r lens I Revived try, (Signature) QE I <br /> I I I 12. trill saeples remain refr gcrated tntit analyzed? ! <br /> po I <br /> IRelinquished by: (S/ii tture) 1 Date/Time I Received by: (Signature) 13. Did artyur <br /> sples rrceived 1 r analysis have head space? ! <br /> I / { I G. )Pere samples in apropriate containers ani property packaged? I <br /> I el ncjish (Si nat e) I Dote/Time I eceived by: -(Signature) I QO ! <br /> �- ry')i r �/t I } r(.,. 11 r �'.•i 1 ,/ I �Signat�rc ]i c Dat I <br /> (J lI� �I � f fl'• 1;1 i1 { i ! 1 i I I i� { __.J ._ _—_._..J <br />