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Phone rSio}782 2110 Send results to: ' <br /> W, (916)786-78}o AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> Sample Identification/Field Chain or Custody Record 801 Riverside,suite C <br /> Roseville,CA 95678 <br /> !!,, { ,�y � / For Shell Ito' s IMI <br /> Site Address: x+211 Shit.>,f 232o ,� Ay - chi CA -F�+�.� wlc zo "-1S-ZY-360V <br /> AEGIS Project#:—�—«' `O AFF:� D <br /> Shipped By: iV (4a, t.t.4/- _ C-r/DL- s+`1Z <br /> Shipped To: -- Shell Engineer: Af er <br /> Project Manager T� (wa _ Hazardous Materials Suspocied7(yes r@a <br /> Sampling Sample No.or Analysis <br /> Point Location Field IDN Date TvDe Required <br /> S� 6111, S3-! ► I I L `ll +b/ti, /S , 1PNf. E� t� I c. <br /> L(/-9N <br /> 1 <br /> Sampler(s)(signature) dh <br /> Field In Relin vis B (si nalurc) Received B (signature) Date rime Comments <br /> ,7/l <br /> Sealed for shipment by:(signature) Date rime: t3V�* y%UJ Shipment Methal: CON,tf <br /> Received for Lab by:(signature) Galen ime: Comments: <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> whaao,isinrt vim WI.hC..y rliknateCopy <br />