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Alone (916) 782 2110 AEGIS Environmental Consultants, Inc. <br />FAX (916) 786-7830 <br />Sample Identification/Field Chain of Custody Record <br />Site Address: <br />AEGIS Project #: <br />Shipped By: <br />Shipped To: <br />Project Manager <br />Sampling Sample <br />v?& i na Date Tvoe <br />Send results to: <br />Aegis Environmental <br />801 Riverside, Suite C <br />Roseville, CA 95678 <br />For Shell Projects Only <br />WIC: <br />AFE:_ <br />CT/DL: <br />Shell Engineer. <br />Hazardous Materials Suspected? ((yes/no):) <br />No. of Analysis <br />_Containers Reauired <br />; <br />Point <br />Munquished Hy k5mr2ainTor, wy <br />L <br />t <br />t <br />Sampler(s) (signature) <br />VardbiwpA Kw (cion2harel Date/Time Comments <br />Field 11) v <br />Munquished Hy k5mr2ainTor, wy <br />pm": <br />Sealed for shipment by: (signature) Date/Time. _2 shient me <br />Received for Lab by: (signature) DaWrime: CAUnments: <br />h t I <br />Receiving Laboratory: Please return original form after signing for receipt of samples. <br />11— '1— . . . jr,.. 11 IfF Pinlle/17e rMV <br />