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Pho(c{)16) 11 U Send results to: <br /> FIX (916)7 6 7ti3u AEGIS Envlronmen Consultants, Inc. Aegis l:nvirom <br /> acntal <br /> Sample Identification/Field Chain or Custody Record 1050 Melody Lane,Suite 160 <br /> Roseville,CA 95678 <br /> i <br /> ' C For Shell Projects Only <br /> Stic Address � WIC <br /> AEGIS Project I9. AFC <br /> Shipped By. � ApL <br /> Shipped To �- �Shell Engineer <br /> Project Managej Hazardous Materials Suspected?(yes, to <br /> Sampling I Sample No of Analysis <br /> Point Location Field ID# Date Type Containers Required <br /> Autu <br /> Samplers)(signature) <br /> Field ID eli si ur Received By(signature) Date/Time Comments <br /> Sealed for shipment by (signature) Date/l'tmc 511Z.141-&oUtsop Shipment Method `� 2 r a <br /> Received for Lab by (signature Datetrune W13hl 6Y S Comments C # 365 <br /> Receiving Laboratory: Please return original form after signing For receipt or simples <br /> Wh1Q0(1rLn.d YLIIUWfi Acopy Pink/1 de Copy <br />