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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date L&1 z'j Ci Lt <br /> RETAIL.ENVIRONMENTAL ENGINEERING-WEST Serial No • page of <br /> Site Address- Analysis Required LAB- Sig V c k <br /> WICN: CHECK ONE{1l BOX ONLY CTIDT TURN AROUNlD TIME <br /> Z04 -��Z�}- I s opt <br /> Shell�nNnesr. L 'r l(e��h—op�No•(x'75-b1 swhivost�ion ❑ 4441 48ha241 ra ❑ <br /> 1�`}} �-1� I'az#I! 5— ~I sol CASs a! ❑ 4112 �e na.s ❑ <br /> Consultant Name&Address-F w S waw 15 dap -1 <br /> 0 b Claw ❑ <br /> V U. lo'la a"''�''0"�0w ❑ e443 <br /> consultant contact, ifa.11i <br /> a No, -Z1l S&*Ram.a ars <br /> .")f b-? Q Dam \91"M NOTE Nary Lanae <br /> Comments: t SVLT a <br /> Wow R~"at�`� ❑ 4455 s ttft TAT a <br /> SLL m c a C 3. UST AC3ENCY;.SRI1 1 <br /> Printed Name. V1k a a o� 0 ❑ m .11 <br /> MATERIAL SAMPLE <br /> x <br /> Semple ID oats sttldpe soa Water Air fonts No of E DESCRIPTION COMMENTS <br /> N� 1 ?_o ►�4� L- AI <br /> I /h <br /> Re uia By{sl ivV Name Date,(of ( 0Maz <br /> Date l <br /> Time �$� Time <br /> Relinquished By(signature) Printed Name Date r— sip Minted Name Date <br /> Time __ Time <br /> Relinquished By(signature) iPrinted Name iDate Received(signature) i3 TRRamNe — Date <br /> _ <br /> Time __ __ _ _ __ __ _ Time <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN-OF-CUSTODY WITH INVOICE AND RESULTS <br /> REV 111/3 SHELL OIL COMPANY CHAIN OF CUSTODY <br />