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GNELL OIL COMPANY CHAIN OF CUSTODY RECORD Da -4pr-V <br /> RETAIL ENVIRONMENTAL. ENGINEERING - WEST Serlal No: Page / of 6A <br /> Site Address: fa CT C QutAW Club 61U SThcktwi <br /> y a Analysis Required LAB: Sed a c, a <br /> IC . 244- 75 a 9 -o a a� 11) CHECK ONE(1)SOI(ONLY C1101 [URN AROUND TIME <br /> CQ /� G W rdonro�lap I—] 4441 <br /> Shall Engineer: Phone No.• U LL :4 hauls ❑ <br /> 6j? 616 8 �}- -� o sr.ray.sflpdfan a41 4s hears C 1 <br /> TT z Fax : 5-.91712 tu r <br /> Consultant Name &Address: O � SoR Chsssur/Disposal ❑ 1147 <br /> F.0. Box 259 — � o V:116days ®(Nagaal) <br /> Enviros Inc . , Sonoma CA 254?6 ° x � Wed.f <br /> Consultant Contact: h ' d ClossliyrDkpa.ai ❑ ���� ❑ <br /> ah.t <br /> Joe Neel P9�7 4V 071 .. � L} SOaIIIA R.matSys ❑ 441: <br /> �' <br /> Ifax I: q 3 -66 4 (D � ,n ty �-J NOTE, NaWy lob as <br /> +— rN WW*I Rom of Sys soon as Fos a In of <br /> Comments: °` �, o � Ws� <br /> � .� � � .n O a M � 21116 his LAY <br /> Sampled by: f S = 3:. <br /> 0 a o & p �, UST AGENCY: <br /> Printed Name; a. m o c- a SAMPLE: <br /> MATERIAL <br /> No of ac 0 E v o a E DESCRIPTION CONDITION/ <br /> Sample ID polo SludgeStill Water Air Canis (r an j U H tri {) d U COMMENTS <br /> — fv <br /> I+ol � �lZ <br /> S~6 f - 15 <br /> X X <br /> l�aDC <br /> Sb - 0�- 6 x A X x X X <br /> Relinq tly a e): Printed Name: Dole.W cf 7 Racelved(Fgnalu ). Prinled Puma Date <br /> TO-6 i to �. IIm4:_�o 2 <br /> R By(rt lura): Prinled Name; Data i e�la I Received(rig ! e). Pdnlad Name DaL�` <br /> S Z�. M n-f j-z-. ILRs:a-1-A-7 Time <br /> RabquWl*d Unature); Printed Name: Dale. Recely d(slQnalure Prl led Na <br /> Dare. <br /> Time. Time: 11 <br /> 111E LABORATORY MUST PRGV[QEkC0PY�w HIM I3 CI IAI (�$ <br /> RY fS cm a uko� <br />