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FEDERATED INSURANCE T r Y/cak C <br /> ® 111.0. Box 586, Citrus heights, CA 95611 <br /> tv s a R r a R It I E O CHAIN OF CUSTODY <br /> �Mf ASSOIIRIICt Or 1391tIIV Novato, CA, 11 Digital Drive, 94949 <br /> Plione 415) 883-6100 Fax 415 883-2673 f <br /> nsultant's Name Aegis Ernrironmental, Inc. Name of Insured Moore PetroleL= Pae / of <br /> dress 1050 Melod Lane Suite 160 Roseville California 95678 Federated Site Localion 1399 a Yosemite, <br />' ect Contact Laura Odenthal Phone#(916)782-2110 Pax# (916)786-7830 Federated Contact Gail Clark <br /> n led b nnt) c— 04,tyn Sampler s Signature J Phone#1910729-2197 Fax H _ - <br /> kpment Method Consultant Project # 90-098 Federated Claim 837-161 <br /> Sample Condition as Received <br /> r ❑ 24 hr ❑ 48 hr ❑ 72 hr 19 Standard(10 day) ANALYSIS REQUIRED Temperature*C <br /> Cooler N <br /> Inbound Sr-al Yes No <br /> m _ Outbound St.el YLS No <br /> kn <br /> mple Description Collection Matrix Prsv of PACO 16)i A i <br /> Date/Time Soil/Water Cont Sample p XQ Q COMMENTS <br /> Fp't0.i1 F W <br /> Z,; _ � 4 ►2 I) a I Lv� � N t_r_ ;� y} �� X <br /> I <br /> 7 <br /> I <br /> t I <br /> Relm shed by/Affiliation Date Time c to bylAfliit Date Time Additional Comments <br /> �1Z 6 Z �o <br /> WIL <br /> M = = ■■� A <br />