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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> - RETAIL ENVIRONMENTAL ENGINEERING .NEST Serial No _ Page of <br /> Site Address Analysis Required _ LAB S ir�il <br /> CHECK ONE(t)BOX ONI Y CT/DT TURN AROUND TIME� <br /> a W Monhoring 11 4461 <br /> Sheil Engineer pho No 24 hours <br /> 1 (�� See Invo5lig illon U 4441 <br /> Fax f <br /> LyN� �f� _ t4e hours <br /> Consultant Name)8 Adfdress / CL <br /> N I S Soil Classdylpssposal f 1 4442 ,{ <br /> IL t LJI t: It)r <br /> l ��l t N �Lt,C-1 �_ t SlJ1�` m Water 15 days ➢EI (Nwmail <br /> \� I_.L Classdylplsposal I � 4447 I, <br /> Consultant Contact- _ _ <br /> rho e No 7B2 ?I 1 G r w Other <br /> rt N 11 ED SoillM Ren or Sys <br /> t' r -7 u�i V CO O 8 M �] 4452 <br /> _ <br /> Fax �is !e � r9 m N <br /> 00 ad NOTE Notyy Lab as <br /> Commentsr�— 0 0 Q In Water Rem or Sys soon as possible of <br /> o a. a O S M 4453 24148 hre TAT <br /> Ul a: w Other 17 <br /> Sampled by — - 0 o <br /> � � C" co co a c UST AGENCY SAP I*wok I <br /> U) <br /> n ' o <br /> t <br /> Printed Name L +�1N CL a UO ain <br /> ° <br /> - - - - ---------- - w w X n y r-o `m MATERIAL SAMPLE <br /> Na of z = w NW a CONDITION/ <br /> Sample ID Date Sludge Sod Water Air a a r- o m E m E DESCRIPTION <br /> conts F- m > a COMMENTS <br /> R i cashed By(sfoaalu Pnnt ame Dale pARe _- <br /> \ (sinature) Printed Nam�L V.— Tlma'Z. ck �C __ NC�Uti11yN Time 2' r <br /> Relinquished By(signature) Printed Name Date R eived(signature) Printed Name Date <br /> _ Time __ __ __ _ __ _ _ Time <br /> Relinquished By(signature) Printed Name Date Received(signature) Printed 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 — SHELL OIL COMPANY CHAIN OF CUSTODY <br />