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go <br /> 6.wr,1 ......,. wd»..,H L�-_.,,y 1»-.��i ar•�l a+r..a r...i....: 1...:�_� a... .- _... —....- - <br /> 11hone(9 Lt., .u,2110Send restrlls Im. <br /> FAX (916)786-7830 AEGIS Environmental Consultants, Ine. Achis.F:nvironment:d <br /> 801 Itiverside,Suite C <br /> sample Identificat iurl/i+ietd Chain d Custody Record Roseville,CA 95678 <br /> For Shell Projects Only <br /> �Zo <br /> She Address: WIC: i7G-y` -Y-///L 1 <br /> : .. <br /> AEGIS Project <br /> ShiPPeY:d B arm: <br /> ShippcdTo:_ /ff <br /> Shell Engineer: <br /> project Manager �c mkIla4ttdous Materials Suspected?(yes/no) <br /> Sampling sample No.of Analysis <br /> Point l.ocalion Field Wit Dale 1' a Containers Ret uired <br /> tnlbA ��„� u�/,+/EMA�f Com•^ [�1— /!��— / ���''`) i a wi�r�'1 __ `?' — �:E <br /> bi- _-S <br /> i <br /> r <br /> I <br /> y /r Nor <br /> ------ <br /> Sampler(s)(signah:rc rs� � <br /> Field ID Rglin uished By(signature) ltereivrd t! (si gnalure) Datc!'1'irne Comments <br /> i <br /> Tib G I C'-'P-01 . , <br /> oC) I <br /> Sealed for shipment by:(signature i ,h Dale/t'ima Shipment Mcdkod: — 1 <br /> }tcccivcd for I_ktG by:(signawre) Dateffli .: y�'Cukkuucnu; U 'N r' <br /> Z <br /> i <br /> I <br /> Iteceiving Laburalury: Please relook original form al'ler signing I'ur rccciµ[of s:tngllcs. ` <br /> Whiar/[Li�it�1 YCIIuwA AL('l' NO./bite Cq)y I . <br />