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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No: Page q of S <br /> Site Address: <br /> 34/ T ` Analysis Required LAB: S1=0"oI A ANA1-,rr ICA it <br /> WIC#: _ <br /> CHECK ONE(1)BOX ONLY CT/DT TURN AROUND TIME <br /> 20� — �5 � � — ��0� G.W. MonNoriny ❑ 4161 <br /> Shell Engineer. p Phone No.: z•hours ❑ <br /> Fox#: She Investigation BA-M1 48 hour ED/ <br /> Consultant Name&Address:r/vy !o5 t S.i f e C <br /> Soil Classify/Deposal El 4"2 16 ❑ rms days (NooD <br /> CAA-( rA EN V!/2ptJA4,ejJTp C. - C-1 N Co <br /> 32water <br /> Consultant Contact: p L" O Classify/Deposal ❑ �� Other ❑ <br /> Phone o.: <br /> SiCz TT V co d Soil/Alt Rom or Sys. <br /> Fax#• a �► "S2 <br /> rA r O S M NOTE: Notify lab os <br /> Comments: d 1 Wafer Rem.or S soon as Possible of <br /> N � O 8 M Y+ ❑ 4/5J 24/I8 hrs. TAT. <br /> O O 43 <br /> 10 se _ <br /> 0 U fl d Z Other ❑ <br /> Sampled by:PO►LIP T 61 T7 C n� � � 8 `a o c (D i <br /> 00 Co a o _Q � h o ;�, UST AGENCY: <br /> 17 N <br /> Printed Name: Q 0.a f'- a J d o c :o SAMPLE <br /> T,wt� `" ° ¢ �-- 94 o a n. MATERIAL <br /> Sample ID Date -61wElp soil wafer Air No.of o o o o (D o DESCRIPTION CONDITION/ <br /> Conts. ,.. co > ,. U Q U n U COMMENTS <br /> ? _ I' 412q X X �N�4 0,4-1,06,( <br /> X X X <br /> 2 A X X X >cA�YZ9 <br /> X X 4- <br /> co•MPoS/ 7?—c- �n/D <br /> SP- 3 A 1: 3 o X l x x X HNAz-rrc SP 3 <br /> ftvnr <br /> Sri- 3 31 ' 30 x 1 x X X AIVD <br /> oa <br /> n y g atwo: J Printed Name: +�F Date: ecelved(signa ): Pr in d ame: ...y� Dale: <br /> �, / C9 me• 1� <br /> a• <br /> Relinq4lihod By(signs ): Print Date: ,l! Received(signature): Printed Na Dale: <br /> Time v Time: <br /> 1Relln4dkh1BdBy(slgna e): Prin ed Name: Date: Race gnatu Printed Name. f jDale:11aS <br /> Time: SQ Time: D <br /> THE LABORATQRY MUST PROVIDE A COPY OF THIS CHA*915f STMY WITH INVOICE AND RESULTS <br /> a,.sora. acwoor <br />