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K KAPREALIAN ENGINEERING, INC. i ', <br /> i {fv <br /> CI[AIN OF CUSTODY " <br /> I <br /> (SAMPLER \ I SITE NAME IC ADDRESS I ANALYSES REOUESTED I TURN AROUND TIMEUvxcal <br /> I <br /> I I l i 1 1 1 1 I <br /> IWITNESSING AGENCY <br /> ✓�`�VQ- <br /> I l I I 1 I I ! No. <br /> I SAMPLE I I } I I I ! OF I SAMPLING I L I I I I I I It N Ie Kt I <br /> I ID NO. I DATE TIME'. I SOIL IVATERIGRABICOMPICONT.I LOCATION I I I I I I I I � I <br /> ICO+�P D I - 921 I I I !V/! L- ! S T O C K P ILL I✓I ✓I v/I I I I I � �[Z� A9 } <br /> ISP C I ! II 11-- I I �/I �/I r/ I I I I } ' 0 AD � <br /> lV I I <br /> CID I I �I I I✓ I I �/I �Ir/I I I I } � Z� � I <br /> ' I <br /> - <br /> I <br /> I <br /> , <br /> I <br /> 1 I I I I I I I I I ! I I I I ! I I <br /> in li Ish S gnatu I Date/Time I Received by- (Signature) [ The following MUST BE completed by the laboratory accepting samples I <br /> L-V <br /> r 'J for analysis. i t <br /> 1. Have all samples received fa_ rprsalysis been stored in ice? ( E, <br /> iRelinqutshed by: urr) Date/Time iived (Si tore) [ V I L <br /> / 1$D USI � [ 2. Will samples remain refriger�untit analyzed? <br /> ll, C <br /> ;Reli shed (Signature) I Date/Time I Received by (Signature) ( 1. Did any samptes received for analysis have head space? I r <br /> NO- <br /> 4. <br /> 4. Here samples In appropriate c�i�ers and properly packaged? I <br /> 1Rrlin}uished by (Signature) i Date/Time I Received by (Signature) <br /> a� <br /> I I I l <br /> Signature Title Date i 14 1 <br />