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P aiP.O.+I;I)E1�A'1' INSU1tANC1? <br /> I liax 5$6, Citrus Heights, CA 95611 <br /> GORPORa; TEO <br /> THI ASS uta+lMt:E OF OU+lllt CHAIN OF CUSTODY <br /> I�[I <br /> 1..A' Novato, CA, 1 I Digital Drive, 94939 "{C <br /> Mimic: (415) 883-6100 Fax: (415) 883-2673 <br /> Consultant's Name: Aegis Environmental, Inc. Name of Insured: Mc)ore Petroleum, Inc. Page of <br /> Address: 1050 Melody Lane, Suite 160, Roseville, California 95678 Federaued Site Loca(ion: 5491 F Street, <br /> Bant- <br /> Project Contact: Laura Odenthal Phone #: (916)782--2110 Fax#: {916 786-7830 Federated Contact: Gail ClAr-jr <br /> Saml)led h ( rin0 eL pa Sampler's Signature: Phone p: 22 Pax M: <br /> 191 Shipmel►t Method; Cunsuhant Project Il: I7L <br /> � �'� Cf� C£ a 90-099 Federated Claim #. 837-162 <br /> TAT: ❑ 24 hr ❑ 48 hr ❑ 72 hr Standard(10 day) Sample Condition as Received <br /> ANALYSIS REQUIRED 'Temperature° C: <br /> Cooler#: <br /> Inbound Seal Yes No <br /> w Outbuund Seal Yes No <br /> Sample Descriplion Collection Mal 'x.. PrSv N of PACE: <br /> f)alc'lime Soi alcr Cunt Sample N x x Q <br /> 1w Fat COMMENTS <br /> 4 i�3s r111.4 <br /> LL <br /> Relin fished by/Affiliation Date Time a ted by/A 4liation Date Time Additional Comments: <br /> a g� U 3a <br /> 1 <br />