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SHELL 01L COMPANY <br /> CHAIN OF CUSTODY RECORD <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Senal No _ Page I of 1 <br />' Sttc Address �9ie �vw�2 SRG M E N r`' Rvn� <br /> 57-0 Ce-Th�� Analysis Required LAMB <br /> Will -- F -- CHECK ONE(k)Rl),{ONLY JO'T/DT TURN AROUND TIME- <br /> 7�0 � —�S� y- cs � b <br /> l'fiimc No 1Quarterly Mrmaz no 5461 24 hours <br /> Shcll Engurccr 0� { ] <br /> Site lnvcsllgatu» [ [ 5441 48 hotuyl [ { <br /> Consultant!dame A Addresa - - - T -- - _-- - _�- Sod for dlsposai [ [ 5442 IS drys (Nurnlal) <br /> cmc-,d 15so c f g rcsq Water for disposal ] , S t43 <br /> I Y3 3 ►J ,(x�=7 j w 3 c� 5�/0 SA'CAVI"zm 6 Other [ [ <br /> Au Sample Sys QticM { 5452 <br /> Consultant Contact rPllorle No 74 794 5500 ] <br /> NOTE Nerdy l,ah as. <br /> Fax N /61 5557!1Y I N Water Simple Sys O&M [ ] 5453 soon possible of <br /> -�s79GG� ol $ Other [ 24/48hrs TAT <br /> Cnrr►mcnts - <br /> NH <br /> _ oho opo 5 D �' SAMPLE <br /> MATERIAL <br /> Sampled By p-„ < A �+ pE5CR1P710N CONDITION/ <br /> Punted Name l J e- (r �� l �, ,J`. COMMENTS <br /> - - - tc X0 c <br /> Sample IU Dale Sau l Water ANo of � F„ <br /> Fonts <br /> n1w - � Ly �J <br /> d /shed By (signature) Punted name -- ---- Date -s]13 14 Re 1 od� gn ) Printed nam <br /> Ttme Gtl Time <br /> RcluNurshed By (signalurc) Printed name Date Retervcd(signature Ptutilcd name hale_ <br /> Time Tune - <br /> Rclmquuhcd By (stgnrturc) Primed name Date Received(signature) I'ruUcd name Date <br /> TIme Time <br /> i <br /> TIIE LABORATORY MUST PROVIDE A COPY OF I'll IS CHAIN O)F CUSTODY WIT11 INVOICE AND Rr-,sUI TS <br /> 1 a+I H.viilon D.11c 10/15/91 <br />