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0 <br /> fi�yK - KAPREALIAN ENGINEERING, INC. <br /> Ci LAI U W CUSTODY <br /> ISAMPLfR I 511E NAME L ADDRESS I ANALYSES REWESIED I TURN AROUHD TIME f <br /> nota � [ <br /> { I ! I ! I I I �Gr .— I <br /> IwI1NESS ING AGENCY ( 7 3D3 P4c+�� /�✓Q S�qG�� I ?�� I I I I I I I <br /> I i I `moi I I I I k I I <br /> NO <br /> SAMPLE I i 1 I i I f OF I SAMPLING I i I I I ! i I It E Nil tt K T I <br /> I 10 NO I DATE I TIME I SOIL IWAIERIGRABICDMPICONI I LOCATION ! I - I i ( I i I ! <br /> I--------- I / i t '+—f—I I + <br /> ice= I { o� � (Q0 <br /> I� I �. ��� - Ivl I , 1 I J I e� S / .� y� I � I 1 1 1 1 1 1 ! <br /> T -� I�--�I---I <br /> I _ y <br /> -Al l <br /> t ---1--�-1—+---I--------I —I I --}---I I <br /> I 1- zo <br /> +--�------+---I—ISI----I----I I I--I 4 + I—{-----I I <br /> I l� 2s �, I I ✓ I I S I I I I I ✓ I I I I I I I t-{. (Q � I <br /> k 3 ,� I I ✓ I ISI Ili ISI I I I I I I {p �v 1 <br /> I--- <br /> I _ yU V1 I r l <br /> I�--- � I---I--4 I--f--+ I---i-----I--I I <br /> v I I v[ I I I I Ix I 1 I I I I I <br /> I <br /> IRellrx?i shed (5i atur } I Date/time I Rec ( tgnatur ) the following MUST BE canpteted by the laboratory accepting samples I <br /> I for analysis. I <br /> I I � <br /> ! + 1 Have all samples ret teed for analysis been stored to Ice? I <br /> 1Relinrt.�ished by (SIgeiature) I Date/lime I Received by (Signature) + I <br /> I I I 1 2 will "Its r refrigerated until analyzed? I <br /> IReItrxluIshed by (Signature) i Date/Time j Received by (Signature) ( 3 Did any samples received for analysts have head space? I <br /> I .. .._ I I <br /> ! 1 + 4 were samples to roprtate containers and properly packaged? I <br /> IRelii".iished by (Signature) I pale/time I Received Lry (Signature) I I <br /> I I I I %--I e /r <br /> I I I I Stgnnture lttle Date I <br /> I <br />