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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No -— Page 1 —ot <br /> Site Address — T— <br /> _ (NJ L ,�� ���: ��7 c-c�I� C �r Analysis Required LAB E: te55— ----CHECK ONE(1)BOxONLY CT1DT TURN AROUND TIME <br /> G Mon�oring �� 4461 <br /> Shell Engineer Phone Not,7 -�t "( 24 hours ❑ <br /> f` L, l �k Q ` Sitelnvesllgatlon �� 4441 <br /> N �~ — ax# "7, thy 4B hours ❑ <br /> Consultant Name R Address fr ca� o sollclasslryrDisposal ❑ a442 <br /> o <br /> 15 days (Normaly <br /> Water <br /> t_G1') LN 5l II,rC_ �_�lL� _9�c�7 ClassllylDlsposal �� aaa3 other U <br /> Consultant Contact (Phone No']�'��?l o F SoWAJr Rem or Sys <br /> Pt�L- `�t � rax# 6 l7 m cm m 08 M ❑ 445z <br /> �' e0 rti NOTE Notify Lab as <br /> Comment MIWSCO3.,+.,L T710 -S't,`"T O N Lf) Water Q � WaerRoofSys 53 soon as possible of <br /> 24148 hrs TAT <br /> ((,Z X62 Y�'4 �-5 � <br /> � � ) p _ Other <br /> ���4`ter � 1� O U � 4' m <br /> ampled by c H m -- ---- - -- — <br /> co g a to o UST AGENCY <br /> '� — - - - Q ¢ a O sn o � --- - — <br /> Printed Name w w w c o 11 �' SAMPLE <br /> — o <br /> X _ m ra a & MATERIAL CONDITION/ <br /> Sample ID Date Sludge Sod Water Air co of a- a- Iw- o m E N m E DESCRIPTION <br /> cants � F- CO > ¢ Q 8 COMMENTS <br /> - -- - - - - - - 0;r , ���� S31 I019$ ACS <br /> A4)rnv V� <br /> — — -- — -- -— — -- - - 117�i�cTt3v1 - --- — ,,nn <br /> M G2 <br /> r, C� <br /> Ref q fished By Isig ural Printed tiarpe - — J -- Date VL AL3 Recel�i$s nat r� Printed Name�I <br /> ,1 nC` �� U Time ;�4OFI -- - ---± Y 1 r Time 1 t� <br /> R I h6 y{sr lure) Printed Na , pate , R e v / Q('j Pnnled Name Date <br /> '�%r Time Trme j <br /> ReAmol is ed' �(signature) Prmt Date Received(signature) T Pnnled Name Date <br /> Time Time <br /> _ THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF CUSTODY WITH INVOICE_ AND RESULTS <br /> REV 4!1193 — — T — �— __ SHELL OIL COMPANY CHAIN OF CUSTODY <br />