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Phone{ 82 21111 <br /> FAX (916),g6-,83o AEGIS Environme al Consurtants, Inc. Send� ' w <br /> Sample identification/Field Chain of Custody Record4 °50Melody� Suite <br /> Roseville,CA 95678 <br /> For Shell Projects Wy <br /> Site Address !_L ._ S1 O5, W1C. 4 , <br /> AEGIS Project#• AFE <br /> Shipped By ACAt CLYDL.. ' <br /> Shipped To +e- +'+c Shell Engineer. <br /> Project Managerr.. Haiaradous Materials Sttspxled?(yesO <br /> Sampling Sample No.of Analilb <br /> Point Laotian Field ID# Date Deg Containers ReguirM <br /> 6 <br /> t } <br /> t . <br /> 1 <br /> E <br /> _ <br /> f � l` <br /> l <br /> Sampler(s)(signature) l <br /> Field ID Re io ' ed l (si nalurc)/ Received By(signature) DatdTime Co "meets <br /> s >t <br /> 1 <br /> y r <br /> Seated for shipment by(signature) Datetrime. /1 21 IP ••a Shipment Method o` <br /> Received for Lab by.(signature) r t� y 4 4— DatC/Ttmc y / �41 /=�4'S Comments: <br /> Receiving Laboratory: Please return origrnal corm after signing for receipt or samples. <br /> WWLJOngmal YcllowA ab Copy Pink/Fda Copy <br />