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70 <br /> 2 2110 <br /> Phone <br /> (916)786-7830 AEGIS Environmental Consultants Inc. Send results to. <br /> FAX <br /> ( ) � Aegis Environmental <br /> i f Sample Identification/Field Chain or Custody Record 801 Riverside,Suite C <br /> l j <br /> I Roseville,CA 95678 <br /> e <br /> For Shell Projects A)nly <br /> Site AddfesS ! --r i y - WIC <br /> AEGIS Project# ` �'' _ Al~E <br /> Shipped By =-- - CT/DL <br /> Shipped To riz Shell Engineer _0, ("7 r %71 r < <br /> Project Manager -- %�' f Hazardous Materials Suspected'?pCc '?(yG51n0) <br /> Sampling Sample No of Analysis <br /> Point Location Field lD# Date 7 Ype Containers Re cored <br /> ! r I <br /> Tinr))J�Q:Ai pr <br /> i <br /> s <br /> Sampler(s)(signature) <br /> Field ID Relinquished By(signature) Received By(signature) <br /> Date/Time Comments <br /> J r I <br /> � r <br /> Seated for shipment by (signature) ,A ' Date/Time ! Shipment Method <br /> Received for Lab by (signature) ' , ( u Datc/1'lmC l t f Comments <br /> t <br /> Receiving Laboratory. Please return original form alters+gning fur retelpt of samples. <br /> What,/OrigwAl Ycllowll A Copy Nik/'dc Copy <br />