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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date � <br /> RETAIL ENVIRONMENTAL ENGINEERING-WEST Serial No _ page aT <br /> Site Add r ss - --— - -------- -- _ _ <br /> [ � L bo �n�`��L�`C Analysis Required LAB — <br /> tNTC* CHECK ONE try BOX ONLY CTIOT TURN AROUND TIME <br />' Shelf <br /> �Engineer �y (7 -� <br /> o <br /> 0 I Montoting 461$Aelnvelpatlon 4A1 <br /> 24hwe LI 4ehoe <br /> Consultant Name 3 Address iLson Clasegy0spoal 4442 <br /> U <br /> c 1 e v 1 i b [� } p lMaSer <br /> L 15 days (Normal) <br /> G � , C v q\:!u,�r(fit Q, to Go Classity0sposal f J 4443 [ I <br /> 01fier --- <br /> Phone Contact Phone No787-)1 c SoPlAir Rem or Sys <br /> )4)L C���� rr r °1 CM m o a M f a4s2 <br /> f=ax# L+[ � `��, coo m_ N <br /> rn ob NOTE NolliyLabas <br /> Comments S N a U) Water Rem or Sys soon as possible of <br /> ( <br /> O a M 4453 24148 lus TAT <br /> a IL o <br /> W = Other l <br /> w) In CM <br /> Sampled by � �� �'� ti� -- ---- - .- � a � F- m � - --------- - -- - - <br /> Co CO a a UST AGENCY �l�% $tel'f <br /> Printed Name --�—--�� ��lr� - CL a w m `m - - ---- <br /> Lu w X m `-� MATERIAL SAMPLE <br /> Sample ID Date Sludge Sod Water Air NO °I a LU o N •- 0 CONDITION! <br /> conte `" E � c � E DESCRIPTION COMMENTS <br /> -ifILXCY k!X Flkkt �4L f r,r_ !i f <br /> 41/141/f, )T�,Pr <br /> 4 <br /> I <br /> Ren Ished B (signs r _ Pnn[r N A ` Date �� - —{ t�!}� t'rrny ar e f bale <br /> _ � � k ���� Trme � !.f _ (J I r lime <br /> Relinquished By(signature) - Printed Name Date fleceived(signature) Primed Name Date <br /> Trma _ _ Trme <br /> Relinquished By(signature)- _ - Printed Name ------ -_ - - Date - Received(signature) --- -- -- Printed Name Date <br /> - <br /> Time T mP <br /> TH_E__LA130RA_TOR_Y MUST PROVIDE A COPY OF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS <br /> I <br /> REV 411193 — SHFLL 04 COMPAN`r CHAIN Or CUSTODY <br />