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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date !o l 't <br /> _ RETAIL. ENVIRONMENTAL. ENGINEERING -!NEST Serial No Page 1- of <br /> Stte Address <br /> I` '7G�,� Analysis Required LAB <br /> CHECK ONE(1)BOX ONLY)CT/OT TUnNAROUNDTIME <br /> Shell Engineer T r j %— ox <br /> X75 . ( i �� GW Monitoring LJ 4461 <br /> Li kL�' y IL1Sne Invesllgauan444124 hoursConsultant Name$ Address XC , Z 4A 72 4a hours <br /> Soil ClassllyrDisposal �7 4442 <br /> CV <br /> Miy ` nJy� ' > 0 Waler 15 daysjNormay <br /> t!YV i ``�L'A—�+ (S�\I (l•.T,qFEa <br /> � ri 5 L—e co ClassllylDlsposal i � 4443 <br /> CanT"L <br /> tant Contact pne NoNo AQ-�1 i w Other <br /> / k�/] - 7 }— So3UA it Rom or Sys <br /> �1 �1 1 -y L R m N rI] O&M I 4452 <br /> _ l _ X#� (�j CO °� NOTE NoldyLab as <br /> Comments _ t'�' 0 0 Q to Water Rem.or Sys soon as possible of <br /> A a o O (L F3 O d M 4453 24148 hrs TAT <br /> 3 tl 0 w W n <br /> Sampled byc. r — -- It, ,n o C w m 011ier-- ---- -- 1 <br /> JJ� 00 mQ �, 0 "-o UST AGENCY t) �' 'Z•'A' �%1 <br /> rn c _ <br /> Printed Name 1 �� ��: P a a.< w O U i6 a @ � N SAMPLE <br /> --- -- - - --- - - w LU x a o a a b MATERIAL <br /> No of z w (4 E a c m E DESCRIPTION CONDITION/ <br /> Sample ID Date Sludge sail Water Air a- a W O rb e} 4 <br /> conts m a a COMMENTS <br /> `l iJ V/l 1 1.1/ 31 0022:7 <br /> 22 <br /> is e By(sign t Pn merle, -- Dat,4-18 Re f re nature) Pr ed 7,—mo <br /> – -- -- – Hate dei ff <br /> Time i�. 6–��_� — <br /> Timeid:g <br /> R�qed By(signature) P ted Date OG� el (s a `_ `,•� printed Dalen-k-- <br /> Time <br /> Time ' V�( _ In: <br /> Fielinquishe By(signature) Printed Name Date Received(signature) Printed Name Date <br /> Time _ Time <br /> __ <br /> THE LABORATORY MUST PROVIDE Y A COPOF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS <br /> REV 411!95 — -- --- -- — ---- <br /> SHELL OIL COMPANY CHAIN OF CUSTODY <br />