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Phone(916)7 W <br /> FAX (916)786-7830 AEGIS Environmental Consultants, Inc. send results to: , <br />! Aegis Environmental <br /> Sample Identification/Field Chain or Custody Record 801 Riverside,Suite C <br /> Roseville,CA 95678 <br /> f <br /> �e r�—T— n_5, J� For Shell Projects Only <br /> Site Address: ►'`i"�r'-' <br /> AEGIS Project: ``O\ WIC: <br /> Shipped By: �s AFE:-- ••_ _-- ,-••- CT/DL: <br /> Shipped To: G — <br /> Project MShell Engi <br /> anager N us Materials Suspected? 0} <br /> Sampling Sample No.of Analysis <br /> Point Location Field 1D# Date T <br /> S Containers Required <br /> l 0 2n �L A'i f� <br /> l.2 <br /> �w <br /> i <br /> Sampler(s)(signator ,3� <br /> Field'�jIID Relin uished 13 1(signature) Received 11 (si natu DatelTime <br /> Comments <br /> S aled for shipment by: (signature) Datefrime: <br /> Shipment Method: ..v: t l> <br /> f Received for Lab by:(signature) Dale rime: Comments: � <br /> Receiving Laboratory: Please return original rorm after signing for receipt ofsamples. <br /> Whitc/Odginal Yellow/t.ah Copy t'inkT&f'. . <br />