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Z3516 <br /> Phone(90 32 2111) Send results to <br /> FAX (910)786-7830 AEGIS Environmental Consultants, Inc. Aeg6 Envl�,.m l <br /> Sample Identification/Field Chain or Custody Record 1050ldeo Lavffle,-& 9''` ' ' <br /> For Sh Projech Only <br /> Site Address i �'C ' �' ' �`' CA WIC <br /> AEGIS Project# 9 OL J0 AFE <br /> Shipped By C Q� CT/IQL <br /> Shipped To I r — _ Shell E neer <br /> Project Manager Ls ' H rdous Materials Stispocted?(yesJno <br /> Sampling ? Sample No.or Analysis <br /> Point Lor tion Field IN Date 1 voe Containers Required <br /> I AME <br /> Sampler(s)(signature) '1� <br /> Field ID Relinquished B (signature) Received By(signature) Date/Time Comments <br /> Swa /' �" <br /> Seated for shipment by (signatu Q- Date/rim�I Z �� l SGC�r%hipment Method * -7— e0c)�C +L <br /> Received for Lab by (signature) Datefrime 1112-,142, QK1u Comments 5i A,,J_�AOL tri 1 <br /> i <br /> Receiving I.dboratory: Please return original form Alter signing fur receipt or simples <br /> WhuLlonginal ye lowA 3h Copy P1411 41c Copy <br />