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CHAIN OF CUSTODY RECORD Dale: <br /> SHELL OIL COMPANY - WEST Serial No: Page Z of 5 <br /> RETAIL ENVIRONMENTAL ENGINEERING <br /> Site Address: Analysis Required LAB. <br /> CHECK ONE(1J EOx ONLY CT/Dr TURN A •U�N TIME <br /> WIC#: <br /> � � S3 Y O � G.W. MonXodnp r❑ 6T V hours <br /> She:[ E�q:ineer: C/ Phone No.: Site lnvesllpallon 4441 A$hours ❑ <br /> r� S/O-G as- 6/7 V4 <br /> J '/ci/1 �/� FaX :6 -_ 72 r-� <br /> 0 Soil Clauity/Ulsposal U 4442 r6 daysXwolwal) <br /> Consultant Name &A dress: /i yy " S . S G <br /> water Ej <br /> {{ � �E'!is-1 nG• .-. Glassily/plsporal ❑ 4443 Other u _ <br /> � � Solt/Ali Rom m Sys. ❑ <br /> Consultant Contact: Phone No.: o a M .452 <br /> 1,/ to•O 700 v 00 NOTE: Norlly Lab as <br /> �y t7 N r1 roan as POIslblo of <br /> Fax#. -w- 1 �7 j} _ rA Walaa Rom.o+Sya. ❑ 4453 <br /> _ (t) d d O�A M 24/46 his, TAT. <br /> ca <br /> Comments: `y 1� <br /> Ch O O +o w Z k Othor ❑ <br /> S4 1 /� 1— U GY z <br /> ~/ `'�' �' Ln g a, a o UST AGENCY: <br /> Sampled by: 1 % co co p © t \ y `a ° N I <br /> o a .Q' AMPLE <br /> a w `o m � `" v o MATERIAL <br /> Primed Name: <+ 0 a E ONDITION/ <br /> � — No.at x zX 15 o -0 o m o DESCRIPTION COMMENTS <br /> SDN Water All a a ►- O ,m. U Q U a- U <br /> Sample ID Date conrs. r m 7 <br /> } <br /> l2Y <br /> f_ � { 3 123 s <br /> { / Racetvad( �Qatur }: Printed Name: Date: <br /> Ro ad By(sl�naturaJ: Pr d Name: Ddt / �3 LU e <br /> eft, Time. Printed Nam • r Date: f <br /> Pr nth Nam: Date: .29' na i Time: L <br /> R lad 8y gnatur : ^ /� h Time: r -� <br /> Ptlnled Na Dare; <br /> Prrntad Name: Dcsta: /rQ Roca a slQnn ro): f lime: <br /> q <br /> RoNn ]1rTTa:/l <br />