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i $ ) <br /> Send results to: <br /> -'- phone(916)7822110 - <br /> AEGIS-Environmental-Consultants, Inc. Aegis-Eorironmenwl. :-- <br /> FAX (916,7867830 Sol Riverside.Suite C <br /> Sample Identification/Field Chain of Custody Record Roseville,CA 95678 <br /> For SheIB Prgeds only <br /> r3;20 �l �oRadlo rf�fio� WIC: !In U_7ss1y-3eClne� <br /> Site Address AFE: n Rei -71 <br /> AEGISProcctS: �5 UG�9 <br /> _ ��L <br /> Shipped By— <br /> iC d n 1G= r - Shctt Englmxr: r '.`1 h GY N <br /> Shipped To: Hazardous Materials suspected! tII(yes <br /> PrWt Manager <br /> Sampling <br /> Sample No.of Analysis <br /> Point Location Field IDS Date T e Containers Re our <br /> SS-s - a•s ' -s � � <br /> 57 s <br /> Samplers)(signature) <br /> Field ID R signal ) Received R As nature Date rime Comments <br /> 1. S. ,55-3. '?//OA-', /(/-61 <br /> �+'S5-e SS• <br /> Dategime: 7-/lt`4G7 �3v Shipment Metlwd: C ,^�r��S•.�'� <br /> Sealed for shipment by:(signature) - - --- - <br /> Racivcd for Lab by:(signature) - e/ DateJPime: Comments: <br /> � Receiving Laborrtory: Pterse return uriginrl form after signing Pur rteeipt of srmples., <br />