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Phone((i16) r r r r rr r r r r ■■r <br /> r Send reults to <br /> Mr <br /> 4r <br /> FAX (916)7867830 AEGIS Environmental Consultants, Inc. Aegis <br /> rgis r <br /> Environmental <br /> Sample Ment ification/f+leld Chain of Custody Record 801 Riverside,Suite C <br /> i <br /> Roseville,CA 95678 <br /> kor Shell Projects Only <br /> Site Address - ~�r r '� ,, — ��1�1 �1 ; �� r W <br /> AEGIS Project# EAL Af E <br /> Shipped By — �6S CUSTODY S CT/DL <br /> Shipped To l'� _ Shcll En cer <br /> Project Manager.�- ' '� '`'t L .i H dous Materials Suspected? (yes/n <br /> Sampling C 11 5 1 Sample No of Analysis <br /> Point Location Field ID# Date 7 ype Contamers Required <br /> � r\ <br /> 7 i _ <br /> Sampler(s)(signaturel' Wj_ t�A' N 4'- J <br /> Field 1D Rel,n uished 11y(signature) Reterved lly(signature) Date/1 Ime Comments <br /> httr <br /> t <br /> �rr <br /> Scaled for shipment by (signature)- / � 1� � Datf-fl ide,` ' ��� C;: Shipment Method �y ((K 4(� <br /> Received for Lab by (slbnalurc) iL„ y r Datt/1 1111CIc/Z_3/1 7_- `'Comments 0- J' k <br /> Retetving Laboratory I'leaw return original lorm alter signing for retetpt of samples <br /> Why LJ(h%1"d1 Yc11ow/1 Ab Ct1ly 1,11AA tic UJIV <br />