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{hone(916)782 21� t Z�� Send results to: <br /> FAX (916)786-78 �° AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> 9 Sample Identification/Field Chain of Custody Record 801 Riverside,suite C <br /> Roseville,CA 95678 <br /> For Shell Projects Only <br /> Site Address: ' WIC: <br /> AEGIS Project#: AFE: <br /> Shipped By: CT/DL: <br /> : <br /> Shipped To: Shell Engineer. ! <br /> Project Manager Hazardous Materials Suspected?(yes/no) ) <br /> Sampling Sample No.of Analysis <br /> Point Location Field ID# Date Type Containers Required <br /> ((J/ <br /> / Y <br /> )pler(s)(signaturiuj - �r <br /> FieldID r' ReGn uisbed B (signature) Received B (signature) Date/Time Comments <br /> -7, <br /> Sealed for shipment by:(signature) DalefFime: '7 ! -% % <o ' Shipment Method: r <br /> Received for Lab by:(signature) Date/Time: Comments: <br /> 4,,,- <br /> I <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> Whit,10, ,inal Yr i—ai.,h r,,x M4fl,ih Cmv <br />