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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale 5-1,77, cj: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No Page a of 3 Site Address �� Analysis Required LAB G <br /> WIC# CHECK ONE(i)BOX ONLY CTIDT TURN AROUND TIME <br /> 0 W Monitoring ❑ 4461 <br /> Shall Engineer Phone No "d0 She invaellgailon 9-4441 <br /> 24 n1w2 E)6rGu 46hows ❑ <br /> !, k• alt Fax # 16 ' "U?z sea Clae.ttrrDlapoear ❑ 4442 <br /> Consultant Name &Address f% ,,/�� t;✓eg ''.^c, o water asaaye )R[Nlrmaq <br /> G x ClasellYlDtapoeel ❑ 4M3 aho[ C3CZnsultani ✓',Onta /V+--a�J-�a Phonf�e No l� / -- 9oNArr Ram or Sye <br /> Z tree— 7- t 0 d m O S M ❑ 4452 <br /> Fax # 7�'3a °� NOTE N111:yLab aa <br /> •' Waler Rem or Sys <br /> Comments ¢ r 2414ae. TAT <br /> -0 <br /> � � � � O O b M ❑ 4453 24146 Ne TAT <br /> ill Other ❑ <br /> Q X <br /> Sampled ay t" t" N <br /> Gr �� ✓� a N cn >- UST AGENCYco oo 54 U rir.� <br /> r rL aa, w O ro �' } N SAMPLE <br /> Printed Name _ 5 5 <br /> -- Lu Lu m o � ;n 0 L MATERIAL CONDITION/ <br /> - --- No of = w vl E c m E DESCRIPTION <br /> Sample IDI--111' <br /> D Dale Sludge sad Water Alr conts � i r 8 a 8 COMMENTS <br /> J cob <br /> �T- 10 `t,y I� — II OUT <br /> Z .� <br /> �D <br /> LEF z- <br /> DID- <br /> 9- J- `� —— Date — <br /> � Data J� cely (� alu el �I Print�d mg. <br /> 9iP t (2igna r ) It9die r Cf t 4 , jig- [� G Time <br /> Time <br /> eta uls 13 { urel P In d Name Date.S R ved(sign e! Printed Name Daae <br /> l_ �n �[�EiL Timer Tame <br /> nqulshed B (signature) Prinied Name Date Rece)v (signalure) Printed ame pale <br /> I Time L. / ) aA L, Time <br /> THE LABORATORY MUST PROVIDE A COPY OF T _C AIN OF/PUS ODY WITH INVOICE AND RESULTS <br /> SHELL OIL COMPANY CHAIN OF CUSTODY <br /> REV V1193 <br />