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i I <br /> Phone(916)78"^110 � Scud results lo: ( <br /> FAX (916)7x 130 AEGIS Environment:( Ionslfltants, 111C. Aegis I:nvi►',....I,"nt:11 <br /> Sample Mentil'iealion/Dietl Chain of Cnslody Itecortl 801 Riverside,Suite C <br /> Roseville,CA 95678 <br /> For Shell Pro'ecls(Illy <br /> oolz ��I�olEu �9 y� t s f AN41i C�a— <br /> Sile Address: WIC: <br /> AEGIS Project N: AIT: <br /> Shipped By: 7/-� C7%Dt.: <br /> Shipped To: S /O 5/OShell Engineer <br /> Project Manager T D(3 !A,, C,,f /+N 6 1lazardous Materials Suspected?(yes/no) <br /> ;sar"o <br /> pling sample No.of Analysis <br /> 1 V49 �7int Location Field IM Date 'Ty )e Confainers Required <br /> I �f - I �9�I I --T <br /> Ei -rz ��c ins EDcr� zea <br /> U - T _ M -- <br /> 3 MU - -3 <br /> Sampler(s)(signature _ <br /> Field 1D 110inr wished Il (signature) Received Ity(signature) Dalerl'ime Comments <br /> 'le4-)/AZI,IMAL- <br /> Sealed for shipment by:(signatu /6 14� Date/ nlc; !I e"I Shipment Method: FFr) OK <br /> Received for Lab by:(signature) ( � _ Date/I'iwc'� 1� ' _ 1 Comments: JL I , , [�- <br /> 100 <br /> Receiving Laboratory: Please return original form alter signing for receipt of samples. <br /> while/(higinal Yclluw/t.abCopy Pint,/hIcQq,y <br />