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Phone(916)782 2110 �ti� <br /> 91G , 78 o Environmental In C. Send results to. <br /> FAx <br /> ( ) AEGIS Eil C <br /> 8� 3 7 Aegis Fnvironmenl.d <br /> Sample Identification/I4leld Chain of Custody Record 801 Riverbide,suite C <br /> Roseville,CA 95678 <br /> For Widl Projtds Only <br /> Site Address i G,=,�-C ���.��� r : _.. wlc <br /> AEGIS Project# �1 CCrt AFE <br /> Shipped By .a `f t _ CI/DL <br /> Shipped To 3 � <br /> Shell Ensu r <br /> Project Manager t -k„ vt-A C --,_-- klac1rd us Materials Suspected')(yes/no) - <br /> Sampling sample No of Analysis <br /> Point Location Held 110 Date 7 Yoe Conlamers Re uired <br /> AV 10 �Y <br /> �-- <br /> Sampler(s)(signature)- =_p,t� 4,�,�_' 1;1 A— AA, <br /> Field ID Relinquished By(signature) R ceived By(signature) Date/?ime Comments <br /> (L-,_ � z <br /> r <br /> ti C��t <br /> Sealed for shipment by (signatu �y_/ Date/1 unC ,1[f 2 3 Shipment Mahod )”`rte C-CL^ <br /> Received for Lab by (signature) DatL[l line Comments <br /> Rcceiwng Laboratory Please return original form after signing for receipt of samples <br /> Whitt/Ongin J WHOW/1 A C irliy Pink/1 de Copy <br />