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� f <br /> jil <br /> i <br /> Mwne(916)782 21 toAEGIS Environmental Consultants Inc. Send results to: <br /> FAX (916)78&7830 1 AegisEnvironmentat <br /> Sample Identification/Field Chain of Ctisto y R cord 801 Riverside,Suite C <br /> �• /Vc r �{�& �' Q� , Roseville,CA 95678 1 <br /> For Shell Projects Only <br /> Site Address: �. Yos err►.�t A I!C MUA-Le ccs s CSI WIC: <br /> AEGIS Projtxi C90�02 8 Ate: <br /> Shipped By: �+ CT/DL: <br /> Shipped To,• CCA 5 ti Shell Engineer. <br /> Pwj=Ma4agef. �za� �/1 — Ham-dous Materials Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field IM Dale Tvve <br /> rr Containers Required <br /> c \ <br /> -0 - L7 <br /> 0.0 -0) C, <br /> 1009 -st'l <br /> fM C\i?_ A ; -C i`.01"P0 S, Ice <br /> Samplef(s)(signature) S1 n V`i n rcA 1 <br /> Field ID U Relin uis ed By(signature) Received By(signature) DatdTime Comments <br /> Scaled for sbiptncnt by:(signaluge) Datefl'ime.- Shipment Method: } <br /> RcccivedforLabby:(signature)- ___ - . ,: Dale/Time:i/�5�9/� l7=f�� Cammews: It<GSL' CUm'00siJfG <br /> -26C c�f`u�► i�1Pr� l��f 9 �,� iri�� coo- So�!>I[ � r7��� Cly Xle( din e,� r7�t <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br />