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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date t <br /> RETAIL ENVIRONMENTAL ENGINEERING•WEST Serial No Pa , of 1 <br /> Sde Adress Analysis Required LAB p <br /> .�L &W7 4-��tJ �. Y q <br /> WIC#: <br /> S `7 SZ�w } �(� CHECK ONE{1J tiQ%OI1LY CUp7 AIiQUrq Ttl�IE ' <br /> l , V ` • <br /> O W Monitoring 11314461 <br /> a Engineer- P a No G1S cl Sle Inmtookm ❑ 4441 ❑ <br /> Sol Clus"YID mW ❑ 4442 <br /> Consultant Name&Address A-EU &pV. <t<, o <br /> �+1 water <br /> to S-Z !.j'1. bb �L � Qom• $ °s C[s.itylDisposat C7 4443 ❑ <br /> consultant44 contact <br /> A `LPhoqo No-'7B2_—�L( ., SaAr Rom or Sys <br /> m Q 6 M 4452 <br /> LabComments a � � 0 D r, Q to Weer Rena or Sys a pew a <br /> nn !' [ N a O 6 M ❑ 44s3 hire TAT <br /> Go <br /> I w x Other El <br /> Sampled by / -t J Ln in = e <br /> 0 o < I I . UST AGENCY 5 UJ <br /> Punted NamekAtj ly a oma. w O g `m Q <br /> -- -- x m o n �`—� b R MATERIAL AMPLE <br /> Sample ID Date Sludge Soil Water Air Foo a- m ? a ` NDITIDNI <br /> m DESCRIPTION IQMMENTS <br /> uish By(sl re — Pri ed — -- 1 l-- Date 1 "� R si tu� 1 � � rented D to <br /> N To J S�_ • <br /> Relinquished By(signature) Printed Name Date Received(signature) Printed Name fw <br /> Time _ Time <br /> Relinquished By(signature) Printed Name Date Received(signature) Printed Name — � 'Dale <br /> Time <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN-OF-CUSTODY WITH INVOICE AND RESULTS <br /> RE'J 411143 — SHELL OIL CON OF CUSTODY <br />