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r� � � rr � r ■� r � � � r rr � � -ti r <br /> Phone(916)7r221 Send results to. <br /> FAX (910)786-7830 AEGIS Environmental Consultants, Inc. 331Z Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record 1050 Melody Lane,suite 160 <br /> P y Roseville,CA 95678 <br /> 7 -_ --- For S <br /> hell PoJeels Only <br /> Site Add=- � Q WIC <br /> AEGIS Projectp - 2�2_ <br /> 0 3 8 AFE <br /> Shlpped By 3 ---------- CT/DL <br /> Shipped To &A Shell Engineer <br /> Project Manager 6'41r Ge - —___--- _---- - Hazardous Materials Suspected?(y no) <br /> Sampling Sample No of Analysis <br /> Point Location Field ID# Date Tvpe Containers Required <br /> MOHIM - 113 g40- 1 !S /-/-7-7T-_ [.rlt <br /> Z LJ - 7- <br /> 3 <br /> 3 /M W - 3 <br /> I Mw - <br /> J� /1Au - S <br /> Sampler(s)(signature) <br /> Field 1D Relm uished 13 (signature) Recejvedjy(signature) Dateffime Comments <br /> Sealed for shipment by (signature:) DaWrlme 410 ShipmentMethod ._ L 1 y o ACV— 'Jo <br /> Received for Lab by (slgn.iture) Datc/rimc _ i ,LI7_ o Pe Commcnls <br /> i <br /> s <br /> Receiving Laboratory: Please return original form after signing for receipt of simples. <br /> WhiedOraginjJ Yellow/I A Copy P,nkfl ele Copy <br />