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4420 <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No: Page ,3 of <br /> Site Address: <br /> 3`4 I �ZAST Analysis 2 y ' Required LAB: -�eou C,1 A ANAi.YTr C,A t_ <br /> Wlc#: <br /> .y t, �1 CHECK ONE(1)BOX ONIY CT/Df TURN AROUND TIME <br /> 04/ — �p z � �a l�T El 4161 <br /> Shell Engineer: Phone No.: 7 G W, MonHorinp 24 haws C <br /> SH.Inv.rllgailon 4u1 <br /> Fax #: t' to now. <br /> Consultant Name <br /> �� &Address:illy G5 S-ir $u;Ie. C. � ,q Soil Class ny/Disposal ❑ "42 <br /> M/3 R/A G N V/1e0k)At " 7 I CC- 110 C, . � X 7 avatar 16 day. � ."orman <br /> Consultant Contact: Phone No.: 0 m r �'°"'�/Dago'°' ❑ "" Olhor p <br /> 00 Soil/Air Rom or Sys. 4152 <br /> SQ0-r-r kla L D Fax#: o �► Q U) p oeM NOTE: NolltyLab a. <br /> Comments: tv w O walor Rem.or Syr. ❑ !45] soon a.Possible of <br /> ' 0 U O ao i j) O A M 24/45 his. TAT. <br /> O O <br /> NO\ DC <br /> C n z Olhor p <br /> Sampled by:Pijli-iP o o 0 0 o D } <br /> Co Co Q O .2 -) W "' O UST AGENCY: <br /> Printed Name: a 0. W a► - o c 0 <br /> _ <br /> I'""c SAMPLE <br /> No.ot x x A -6 E 0 � a E MATERIAL CONDITION <br /> Sample ID Date Soil water Air conts. m >° °' {°� l� Q (1 U DESCRIPTION COMMENTS <br /> 4lz4 J2;2 o X 1 XX X 6041814 <br /> T-z C 1 Z'i o X I X x x 6041815 <br /> T- 3 w /J;S-o X I k X x 6041816 <br /> - 12;2 X i x X X 604181'7 � 9 <br /> WSW x 1 X X X 6041818 <br /> i- 3 j2:lo x I x x 6041819 <br /> utsh gna � Pled ame: // Date: O Rec ed(sl nature)• Printed Name: ---ten —Da fe. l <br /> e• <br /> Relin By(slgna Printed me: Dafe: • Received(signature): Printed Name: Date: <br /> Time: 1"U0 Time: <br /> Relingt,Athed By(dgnahre): Printed Name: Date: Re sign Printed Ne: Date; IjklF <br /> Time: 1. SAr Time: <br /> tMpCM olCuldlr <br />