Laserfiche WebLink
SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date 2t <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No Page of - <br /> Site Address I(A 60 Analysis Required LAB GE-C9 Q 0 - <br /> wlC#• - - - <br /> '�w q— CHECK ONE(1)BOX ONLY CUDT AROl1N0 TIIYIF <br /> SMI nwr Phone No� 5 riL aw Monloring .4e1 <br /> t—\tNA] t�_ ,A,J O-Et id'X# S / Ste Investigation Ll4"1 <br /> Consultant Nammee&Address <br /> _ �[Qt� 309 ClaaaltyrDlSIMM ❑ 4442 ° ❑ <br /> a <br /> N t iNormal) <br /> O yyagrr <br /> C SEU 13101 Claaslty/01sposal ❑ 4443 [ <br /> consultant riled co <br /> Phone No'> --ZilO S091AIr Rem or Sys <br /> CD o a M <br /> Fax Zf � a o _ g bd a52 <br /> # <br /> Not1y lab as <br /> Comments Q 1p Water Rem or Sys as possiblepossibleod <br /> a <br /> wnn_ , I O O a M ❑ 4453 hre TAT <br /> 1•�i6 �Sl}L try rLV b�?Lr Ci �'U f 9 w m <br /> Sampledby = Other <br /> 0 oa e, UST AGENCY-!Svl� ob <br /> Printed Named -� -- w_ wc --- MPLE <br /> x = 0 -0 SMATERIAL <br /> Sample ID Date Sludge Soil Water Air No of = `e m DITION/ <br /> j Q m DESCRIPTION MMENTS <br /> p - conte p- «Z <br /> NIL A� �� <br /> 5 <br /> -4- <br /> _ f <br /> a By to ) — Prfnled Data -- n i f –_ Prod --- imto <br /> e <br /> �r- Time (_j _ <br /> Ftaiklg hed By talpnature) Printed Name Date_— Received(signature) Printed Name to <br /> Time ime <br /> PAlinquishod 8y(signature) -- - Printed Name Date Received(signature) �- N nted name — — — — to -----� <br /> Time - <br /> -- ime <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS C AIN QE CUSTODY WITH INVOICE AND RESULTS <br /> REV'41IN3 — — -- - - - -- "- SHELL OIL C01rFP 'HA USTODY <br />