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r^ W Send results to: <br /> Phone(+916)7, ,M AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> FAX (916)756-71130 801 Riverside,Suite C <br /> Sample Identification/Field Chain of Custody Record Roseville,CA 95678 <br /> Nur 5heli t'nrjccts{)nty <br /> LP LD _ WIC:MR z�4- g41ia-G? <br /> Site Address: AFE: <br /> AEGIS Project N.-1.p ` O <br /> CF/DL: <br /> Shipped By: Shell Engineer L� <br /> Shipped To: S S <br /> Hazardous Mat0-0erials 5uspcctcdl(y <br /> project Manager <br /> Sample No.of Analysis <br /> Sampling Dale [ e Containers Re u'red <br /> Point Location Field lIID# - } <br /> v 45,kE I,tw — l Z� Q� ,I;,�, 1 �a2C, 1167Z—I 3 <br /> yL"iJ -� L) - <br /> -` <br /> %,-1 LJ <br /> ;,,L�Hatt EL <br /> 1,12¢ Fw t i <br /> Sampier(s)(signature) Dalefl ime Comments <br /> Field lb HRelin wish B (s'r nature) Received B (signature) <br /> Datef%ime. S ih pmeni Method. <br /> Scaled for shipment by:(signature . 1 <br /> Dalc/1'imc: +I`Z 3.4/ <br /> Received for h by:(signatu <br /> Lu1�'—� Camnunts. <br /> Receiving Laboratory: please return ori}1inal form after signing for receipt or samples. <br /> Whiwo,iginal Ycnnw/1.2b Copy i'inkl do Copy <br />