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• i <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No Page of <br /> S119 Address: C Analysis Required LAB <br /> WICK CHECK ONE t11 BOM ONLY CTrOT TURN AROUND TWE <br /> _ _ Q W manAalnp ❑ 44e1 T --_— <br /> Shell Engineer, Phone No Y7c 24 ha+re ❑ <br /> 1 ; r��16 SiteInvaeli4alton 4441 <br /> _ Fax tT tv e .ana.• ❑ <br /> -- _ .. Sall Claaairyrplaposal `� 4ux <br /> Consultant Name Address a <br /> water lad■r JR-(Norns!) <br /> ✓C �`C�'k ms co clanlly/Olepn.at I 1 4M3 <br /> -Co-risuflant Contact - n Pharos No ( 6 ^. q So�Ah Rem or Sys <br /> Dam t7 4452 <br /> ` Fax ew- °a na�e# 7Y/ a m Werar Ram or Sys ms pm"d <br /> Comments a o O•to ❑ 4153 2414e M TAT <br /> 0 w i Other El <br /> LO P y <br /> Sampled b . — ¢ ` >- UST AGENCY- u� T <br /> 4 CL Q <br /> Printed Name 6'f _ c 3�ri _ _ a w w �_ o m ' MATERIAL SAMPLE <br /> E E DESCRIPTION CONDITION/ <br /> Sample ID Date Sludge Sod Water Air <br /> No <br /> tsl 0 fm + ti COMMENTS <br /> -ts -- - <br /> IV <br /> --03810 <br /> 056 1u.° 5 <br /> 11 -T <br /> Rai bed d lure Print Mims _ Data aceive sl lure), Prk to ams / Datal�Z L <br /> / I d r~ Tlma I��Z-'? t`" c Cf ��/ Tima <br /> _L _ <br /> of uisb a1 lure) Prl t Name Dai*.Z, Z ? R (signatu Printed ame Data <br /> ,4 1 �i Time d _ + _ TLna <br /> uiiltedOwfigpnawra) Prin ed Name flats ecelveYrignatura) Prinlad IIIn Data <br /> TIrnB g 1 rnan n Tlma <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN bF-CfCM WITH INVOICE AND RESULTS <br /> REV 411413 SI IELL OIL COMPANY CHAIN OF CV5TOOY <br />