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i <br /> Phone(916)w 110 bend rc5ultti to <br /> FAX (916)7116 7910 AEGIS Environmental Consultants, Inc. Acgis I nvirontncntal <br /> Sample, Identification/Field Chain of Cu%tod Record + logo Mc1 os Lane,Suite 9 1Go <br /> I Y /' � Roscvllle,CA 95678 <br /> C.rF��I <br /> I J 1 /� j hnr cthNro�ictti Unty <br /> Site Address - TC / ��' ' '' ye , ` r '�' ` C <br /> AEGIS Project# r( ' ATL <br /> Shipped By CP CT/DL <br /> Shipped To _ Shctl Engineer <br /> Project Manager ���) tom+ r� 1 Hazardous Materials Suspected?(yes/no) <br /> Sampling Simple No or Analysts <br /> Point Location Field ID# Dale 7 vpe Containers Required <br /> r! t', <br /> I <br /> Ai, - Of - ►� <br /> j <br /> C / ,7 l <br /> c <br /> Ak <br /> Sampler(s)(signature) <br /> Field ID Relinquished By(Signature) Received fly(signalure) Date/I ime Comments <br /> I <br /> I <br /> _ I <br /> Scaled for shipment by (signature) i'�>/ ii- DatefTMrne ! rK ' Shipment Method <br /> Rcccivcd for Lab by (signature) DatLl1 Mme Comments <br /> rr ) <br /> a, ' C a'�1��.' �1/I�t�`I 7 1/i <br /> Itcceiving Laboratory Pleasc return original Corm alter%ignntg for receipt of samples <br /> W111rL/Or3gm iI ytthow/i All(ij)y PIA/1 do Copy <br />