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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale <br /> _ RETAIL ENVIRONMENTAL ENGINEERING-WEST Serial No _ _ Page of ' <br /> Site Address ---- - - -- - -- - <br /> �`�� c .`,c ► ��_ �iI'!'[t �,�'�� , Analysis Required LAB <br /> WIC# -------- - - - - ------ — --- <br /> _� CHECK ONE 11)BOX ONLY Cr+Dr TURN AROUND 11MF <br /> C W Manrionn I 4461 <br /> Shell Engineer - - -- - Pbone No I,"_j i'- a I 1 <br /> I , l�(r / 24 hours <br /> y . Sao ti+vasl>Aauon 1 I 4441 <br /> I e __' __ �` Fax# I (� k 2? 48 nor»5 i I <br /> Consultant Name 8 Address > ti��W '- m _ p Sad ClassllyrDrslws d i I 4442 <br /> (V <br /> i <br /> L r, p roar IN 15 d iys I�1 (Norrr1il) <br /> r ( ;_�_ _ ___ _ _ <br /> -L � � ' •i. �y1 t t r f \� � Clzs sdy 111..{>u rl I I 4443 <br /> Consultant Contact rn Phoni No"r' ?I t I- u',i Other I 1 <br /> p F_ SadlArr Rem or Sys <br /> �_' t�V . , in N co o a M 4452 <br /> 11 <br /> _ __ _ <br /> Fax # i,t, `� M 41 °d NOTE Noldy Lab as <br /> Comments — 0 u) Wvor Rom or Sys <br /> N Q �,I soon as possible of <br /> -0 <br /> -0 <br /> co tallFS O 5 M f`1 4453 2U48 his TAT <br /> Sampled by_r , ��, �_ --- u2 Ln CM c`"i a a Dinar 1 I <br /> .`C` b� _ti►r o o � G a t- w Q <br /> Printed Name 'r <br /> °° °° Q P a cA } UST AGENCY —Ar, i�4��,iN <br /> 0 <br /> -'lc : _ _r .��:�, -- - - a a w 0 ra m w SAMPLE <br /> ---- Lu w m p` c c <br /> $ MATERIAL <br /> Sample ID Date Sludge Sod Water Air No of a. z r- ro N E n E m E DESCRIPTION CONDITION/ <br /> P - -- �- cants m � ¢ � COMMENTS <br /> r•, fir' )1 1 r1.144c_ \` <br /> Fielr lshe By(sig Lure) Prig a e Date I� I Received s+ Rahe / <br /> � �r- <br /> �� 19 C f nnl d Name t Date �1� <br /> _'�' - Time L�}Q1-LL� -�i „� lri� '! '� 1711 ( ��Ltl _ T1 i. <br /> Relinquished By{signature) Printed Name D_aie Received s1 [ure l+ t {l L ' { Time <br /> 19 ) Printed Nam Date <br /> _-- Time Time - <br /> Reilnqutshed By(signature) Pnnted Name Time <br /> - Received(signature) Printed NameDare <br /> -- -- --- -- — Time Tim_ <br /> RFV 4-1119-3 e <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS <br /> - '__ ---- -- - -- — --_- - - - - -- - - --- µ-- - --- - <br /> SHLLL OR COMPANY CHAIN OF CUSTODY <br />