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FA' <br /> (916)7. 10 - G, Send results to: <br /> AEGIS Environmental Consultants Inc. <br /> FAX (916)78 Il c f Aegis Environmental <br /> 7� 801 Riverside,Suite C <br /> Sample Identification/Field Chain of Custody Record Roseville,CA 95678 <br /> i For Shell Projects Only <br /> Site Address: <br /> WIC: <br /> AEGIS Project t!: AFE: - J <br /> CT/DL: 7 <br /> Shipped By: j <br /> Shipped To: �' Shell Engineer. <br /> Project Manager — -- --- Hazardous Materials Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> 1 Point Location Field 1D# Date I'voe Containers Re uiredAy <br /> , <br /> J <br /> / J J <br /> S )er(s)(signature) <br /> Field ID Relinquished B (signature), Received By(signature) Date/Time Comments ! <br /> I <br /> I <br /> Sealed for shipment by:(signature) Date/rime: > > ' 7 ` Shipment Method: r <br /> Received for Lab by:(signature) Date/rime: Comments: <br /> Receiving Laboratory: Please return original form atter signing for receipt of samples. <br /> while/Original Ydlow/l.uh Copy Tink/tile Copy <br />