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1112 107 <br /> SHELL OCL COMPANY �I— I[ CHAIN OF CUSTODY RECORD Date: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sonat No: ! ! �'(`t ( pag© ` of <br /> Silo Address; j <br /> 620 W. Charter Way„ Stocktou-, CA ,[ Analysis Required LAB: <br /> 141C1J: 204-7524-4305 CHECK ONE(1)BOX ONLY CT/DT TURN AROUND TIME <br /> Shell Engineer: Phone No.- (5.10) G BBonRorfnp 0 usl 94houn ❑ <br /> i Alex Perez 67416$ sB.ray.,rll�dloa tut <br /> Fox : 675-�-61.72 0 � � A,hau� [] <br /> Cant�Ia no & vices, V Sam Claulh, to 1a) ❑ '"a ®sNorman <br /> BlaineAiaxec Services, Inc. t6 day, <br /> 1680 Rogers Ave. , San Jose, CA 95112 CO CO war., <br /> Cansullanl Contact: Phone No : (408) c c'°"Vyf0 L p°`°I ❑ "" O1h.r ❑ <br /> Fran Thie 573-0555 �' cU a SaRlAkRom ofSy, ❑ <br /> Fax #• as '� Oaµ "SZ <br /> 3-7771 U, Q ,n Not( Nollfytab or <br /> COmmOnIS. l Waf.r R.rn or Syn ,00n a 1o;rlbla of <br /> 17 N r� � O&M ❑ "63 91116 hr, TAT <br /> Sampled by: N [ ° J 9Z z Olh.r ❑ <br /> co da °o Q o MATERIAL UST AGENCY: <br /> Pr1r11Qd Nam© 7'CJhr� atrr d d y m ., <br /> L u m 0 71 4 s 0 6 ° If SAMPLE <br /> x F Jr E <br /> Sample ID Dale Sludge Sap Wolof Air conNo of ,�_ 4 ° �' ° ` o W o DESCRIPTION CONDITION/ <br /> I1 `° > U U U COMMENTS <br /> Rehnq s tl By signature). PrinXd amo Dale ZI lRocolvo—d signal e) Prl�Name. _ polo <br /> V 010?/ • �1'r yr Tlmo c1 v ,4 c�L r e <br /> Inquls 9(slgnaluro) Prinlod Name Dale o d (signal ay, Prinled Noma, iF /+ Dale Ll as <br /> Time C5 Se(r 9S-a Time - <br /> • Rell Lrlihed (slgno To) Prinl d Nama!} Dalo,ll Roc IVo ra) Prinlodtpi�Vv_*_ <br /> DaleiTime Tlmo <br /> iE <br />