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r <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING o WEST Serial No Page t of <br /> Site Address Analysis Required LAB/ <br /> SF Ifs <br /> WIC# CHECK ONE(1)BOX ONLY CTIDT TURN AROUND TIME <br /> G W Monitoring ❑ 4461 <br /> Shell Engineer 1�110 No ' l `1 ❑ aa4124twurs ❑9 � <br /> ��,5 She Invesilgation <br /> >LC 0 <br /> T <br /> 61 S& Soll C4usityfDrsposal ❑ 4442 48 Nrus ❑ <br /> Consultant Name&Address l fit 7 8, 15days $,(Normal) <br /> z ivi,E LD M LP S bb q l� �. Water <br /> x classuyrolspasal ❑ 4443 Other ❑ <br /> Consultant Contact �� h e NO t m m S a AJr Rom or Sys <br /> `P C� �''� a -�� ���3� ro ad NOTE Noilfy,Lab as <br /> Water Rem or Sys soon as possible of <br /> comments0— a O 08M ❑ 4453 2414Bhis TAT <br /> - 3c�Il d E 0 til _ co � <br /> T. Other <br /> Sampled by L r >n o � b a m y <br /> � m C USTAGENCY <br /> Printed Name,:Ah L,t�� a a w O o c " SAMPLE <br /> w w _m o MATERIAL <br /> No of z = ;a E c a CONDITION/ <br /> Sample ID Date Sludge Sod Water Air conte DESCRIPTION COMMENTS <br /> IV V <br /> 17) Ito <br /> eI quis ed By(si ure Print s Date Recj (si 1 1 Pnnted Name Date <br /> (� C —7't +` Trme G:?.� [D 1-�C'1, . C.• C �J 3� Time f <br /> Ri Ish signature) Printed Name Date ' R ved lgna re // Pr � bate <br /> �? 91"as <br /> (� Time T �.f�jr! L�!��� Time <br /> Relinquished By{ gna re) 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 41113 �� SHELL OIL COMPANY CHAIN OF CUSTODY <br />