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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No Page l of Z <br /> Site Address — <br /> $ Analysis Required LAB E-r <br /> WIC# -— — -- - <br /> 4 4 -- <br /> CiiECK ONE(ti BOX ONLY CT1DT TURN AROUND TIME <br /> l(o-o So� -- <br /> G W Monkoring ❑ 4461 <br /> Shell Engineer P oe No �- <br /> 1v}�tL t q6 She Invesllgalion ❑ 4441 24 bourn El{✓ Fax # 46 near. ❑ <br /> 4442 <br /> Consultant Name&Address N SoA ClassilyrDisposal <br /> �� _ �{ 15 days ❑ (Normal) <br /> 0 Water <br /> Na,, r �[]N�pyw 16�1t)s to �" X Classify/Disposal I_] 4443 cher <br /> ( oo sultanl Contact hone No r. --� <br /> \ iw—. SolllAlr Rem or Sys _ — <br /> EV��0 4 (.S t�� l6 N y N ED O 6 M �� 4452 <br /> Fax # bt:}83n Ic ar ori NOT of lams <br /> Comments 0 Q .� 10 Water Rem or Sys soon as possible of <br /> 0 Q.. p O b M CJ 4453 2414e l" TAT <br /> O a T W 00 <br /> Sampled by C3 T v other ❑ <br /> 113 � (V U a_ to <br /> Q 0 8 c N : } UST AGENCY So�4liv\CQt <br /> 0 in r- <br /> Printed Name <br /> SAMPLE <br /> MATERIAL <br /> Sample ID Date Sludge Soil Water Air No of a a W o m E E DESCRIPTION CONDITION/ <br /> conts m > rN rl COMMENTS <br /> .5P 1 ��si 1 B t — — - --- -- r C All �i prov,' BTEX,, <br /> � R .er oyt <br /> C-D 13 <br /> - - — - — <br /> ,SMA- Ic'PLIQ <br /> in s d Msfgna I Print Na i}ate / ne (sprinte me ate <br /> ig t rel b <br /> ��'` (( �G ►w <br /> C �L Time — Time <br /> _ <br /> Relinqu}sh a! printed a — Dale ec I ed{sign Ie Printed Name Date <br /> .OATime Time <br /> Rell a By(s are Print Name Date ec d si fur ) Printed Name pate 2-0 4— <br /> Time --— /� A Time ite <br /> THE LABORATORY MUST PROVIDE A COPY RIN <br /> OF THI O STODY WITH INVOICE AND RESULTS <br /> REV 411513 — SHELL OIL COMPANY CHAIN OF CUSTODY <br />