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r r�r r r r r s rr r■ r r rr il■M <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale q-j►e� f�z <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No �FZ v page J of I <br /> Site Address �-Z �7 �i1,�,�� },� 1{ �,:,��-� L{tr��� --' <br /> Analysis Required LAB: <br /> w1C# CHECK ONE(1)BOX ONLY CT/DT TURNAROUND TIMF <br /> _ c_h4 - 4411v — <br /> 5hc1l Engineer pfi me No I� Quarterly Monitoring NV5461 24 hours ( [ - <br /> SlnvcsttgatioKuui- 1) FIR M 46 hours <br /> Consultant Name dt Address - Soil for disposal 5442 15 days (Normal I <br /> l -k )l• �r7 �;, ? .. r. Water fix disposal [ j 5443 <br /> consultant Contact i Phone No `l r(s• •• odw + [ <br /> Air Sample-Sys O&M [ � 5452 <br /> Cly S 3 3 Water Sam k-S s O!I<M S4S� NOTE Nolify Lab as <br /> 5I ti l 11 K—/ Fatt q $ -33 4) $ g N P y soon as possible of <br /> Comments a ' (� _ Other L 1 24148 hrs TAT - <br /> rewl <br /> 0 <br /> Po <br /> Sampled By ill h 4 O A o MATERIAL SAMPLE <br /> Printed Nurse <br /> At DESCRIPTION COMMEINTS <br /> 5ampk ID _ Dalt Sal Water Air No of <br /> cconts p4 > 1 y <br /> t & <br /> _ s <br /> n1-./ <br /> 4 cli _ (iia tire) -- - --- Pr led _ <br /> �pamc Dat Zi _ _Received- gnature)- --_ T Printed name <br /> IilNtil�� Time ftJS 5he2dzi" : Time <br /> Rc Yjuis fly (signature) Printed name Dale, Ira r� eccav ature) Prtnl�e^d amc Dale_ 4D <br /> - Time 5, •J- [Is�� Time <br /> Rel n fished stgnaturc) Prtnle a ate e V ei (si afore) <br /> �t> ef`-� �• �'tX�� Time G•�ca Gas. �� Pant Jn}�e---c - Date <br /> f�[�f c/ I c�'�� 1 Timc f.Jb7ty <br /> TIIF LABORATORY MUST PROVIDE A COPY OFTIIIS CIIXIN OF-C 1{ STORY WITII INVnI('E AND R ) <br /> f.S l LTS <br /> ,,t Itivulon Daae 111/15191 <br />