Laserfiche WebLink
SHELL OIL PRODUCTS COMPANY CHAIN OF CUSTODY R ORD <br /> `:WIC OR FACILITY ID: Date: Results to: <br /> O Consult. Page .0 7- of <br /> O r I �� G' �j ' T� j � Q Shell <br /> 7 CLASS TYPE/DETAIL TYPE Select one only. <br /> Site Address: I '.G ;n„ +�--i c. I Q Site Invest(4441) Q Wtr iRhrn/Sys(4453) <br /> Consultant/Contact; <br /> .'.Ad4ress: t ')G dt c =1.. >=_ Q Soil Clas/Disp(4442) 19 G.W.Monitor(4461) <br /> Pngne: . _ Select one only O Wir Clas/Dlsp(4443) O OtherTURN AROUND TIME { <br /> Shell Engineer: .� -�? t:. Q 24 hre.O 48 hre.Q 15 days(Normal) Q Other <br /> --•.:.: ,._ I Q Soll/Air Rem/Sys(4452) <br /> W=titi Protocol StartTlma `�',ti i) / , Analysis_Required <br /> ` :ar '1d - -- - <br /> .Numbi:► (military} GJ �/ j! r SAMPLE MATRIX . Select one only ti <br /> Sim led m O Water Q NAPL Q Sludge Q Sedlrrient , <br /> in 10soll Q Vapor O Bedrock O,Other <br /> G U {" Ani � QL3 E _ � " LAB USE ONLY <br /> UST r c d o L5 ,n u� �° '• r? �' <br /> a en m a o a °0 v N y Lab Tracking No.: <br /> Agency. Sample Time N a m X �, v <br /> t e nl rJ ;g [l A m I>_ W T M m U v 1- <br /> Field Sample ID �mllitary) o U r a a m a n- n- as <br /> w m o ° v Sample Condition/Comments <br /> a U U i— m r— r— H H 2 > rn i- o. P <br /> 1 <br /> m Z- �� �� `/ '. C. N Cooler Temperature: <br /> E C r <br /> E <br /> D <br /> • Material Description <br /> i <br /> R nq Ished By ature): Printed Name: Date: Recelved Sy(signature): Printed Name: Date: <br /> NDEel <br /> V&I ,L,,.el <br /> i Ume; `N.. �v� U �l� :1� Time: •0-t' 3 <br /> Relinquls d By(signature): Printed Name: Date: Received By(signature): Printed Name: Date: <br /> ' Time: Time: <br /> Relinquished By(s nature): Printed Name: Date: Received By(sign77Jlblf, <br /> ): Printed Name: Date: Sy <br /> Time: ' Time: <br /> FORM BYIMTR N TN LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF CUSTO WITH INVOICE AND RESULTS sHEuc NOFCUSTODY <br /> ■ <br /> .. ,. . .. REVISED 12197 <br /> ' _'__•-�-���—.. .—��--..„-'•'--�f— T ��.,-�+�+�-mow - <br />