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� SHELL OIL PRODUCTS COMPANY CHAIN OF CUSTODY RECORD <br /> Results to: <br /> Date: <br /> WOR-FACILITY I.D: I J 0 Consult. Page u f of. . D Z <br /> . i i- (.' 4:. L� O Shell <br /> 7 CLASS TYPElDETAIL TYPE Select one only <br /> Q Site Invest(4441) Q Wtr RemlSys(4453) <br /> psi e ddd>•t3SS`_ � <br /> 3 y,�.._• Q SoU Clao/Dlsp(4442) (D G.W.Monitor(4461) <br /> onsultantlContact; <br /> tr_�r 6^C �ti 1- U AROUND Select one only <br /> O WtrClaslDisp(4443) Q Other ' <br /> Q 24 hrs.Q 48 hm.0 15 days Mamiall Q Other <br /> T.�����' �� Q SolllAir Rem/Sys(4452) <br /> vil�F glneer: (�� Analysis Require <br /> Start Time ;� "i b �'.. SAMPLE MATRIX e <br /> (mllltary) 0 �3 [1 N �= - S lett one on y. <br /> rR4gr6 C)_ o .� ® Water Q NAPL Q Sludge Q t3edimenf':+ <br /> •c +':ii: "' LOz' Q Soil Q Vapor b I9edrock' <br /> N _ x -� �n �n s v s ,� LAB USE ONLY <br /> •7 'r!' c a: r' W (V 2 p n <br /> UST Sample Time '" m m m o v `' a s Lab TracicingttNo.: <br /> o r N a s X a� ui ` = ��- <br /> Agency: E- Q z z x a_ f- U p v w -- <br /> Field Sample t� (military) o a m o a o o:, m o L Sample Condition/Comments <br /> . r7 y cf' .� �► kl �� ��' 8 bS d9' <br /> . - { � � } `' �1 � •� ,Ji � as �i IFI <br /> Cooler Temperature: <br /> �C 4 Material Description <br /> Printed Name: Date: Received By(signature): Printed Name: Date: <br /> qulshed signature): r . ��y� <br /> Ct S"C'� P r s Time: �'~` f �6u Time: 1. <br /> yFrri"nted Name: Date: Receive y(signature): Printed Name; Date: <br /> Relinqu hed ey(signature): ` '�' <br /> Time: Time: <br /> C ? Printed Name: r-Date:__. Received By(sign ut ): Printed Na"N Date: oy <br /> Relinquisheey(signature): Time: s GO( Timr'THI^ O1 11 RY MU57PROVIDE A COPY OF TH1S7 �IN CUSTODY WITH INVOICE AND RESULTS RMSM ■ <br /> FORMS 4 � <br />