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SMLIIL CQM AP NY ; t11• tl <br /> CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No3j Z <br /> Stte Address Page of <br /> $ O L } <br /> V l LAR T, , t 0 Analysis Required LAB C <br /> wlc# — <br /> �� CHECK ONE 111 BOX ONLY CTUDT TURN AROUND TIME <br /> Sh�3ol Engineer e No 0 MnnAorino El 4461 <br /> C,7— l �M �FaTt ox #�}-+r�{'!.i q(,, She tnvesilliallon ❑ 4441 24♦hours ❑ <br /> Consultant Name&Address o SoIiClasslly,Dlaposel 4442 46horrs WFq as o <br /> 6{{� W�$r, ` �./ i f/� water 15 days ❑ (Normaq <br /> r ►I�tr �oMWp'L Iba o o x ClazsllyrDlsposal ❑ 4443 <br /> onsu tanntact hone No ,� Olher <br /> }b2-2l l6 m O H SoiIJAIr Rem or Sys <br /> E)Ay6--Po tt (.5�� u' �, m <br /> Fax >Y 9(:}83a ro of N ,a O a M ❑ 4452 <br /> Comments in Q h In Water Ram or Sys NOTE Noilly Lab as <br /> EV .- 1001196 possible d <br /> 7 ' dQ 8 N <br /> ro 111<53 24146 In TAT <br /> Sampled ayin in 4 L) y = other ElQD <br /> r � CO CO ¢ � � o � � f UST AGENCY oa t,�iv1 <br /> Panted Name �� C, L J� w w w m o c a <br /> x = °z: x .n w $L MATERIAL SAMPLE <br /> No Sample to Date Sludge Sod Water Air rite♦ ; E - cl E DESCRIPTION CONDITION/ <br /> c� `r COMMENTS <br /> LA <br /> ` S t erav1 2 WT'EK/ <br /> 7�4q of <br /> 1n s d siKLI!!�9)) Print e bate I y Recely net re Prinie a Dala <br /> `n _ Time Time <br /> Relln Print" me bale ecel d signaiur Printad NameTimeData <br /> F1 n e { Prl Name Time <br /> Date Rec ry ,I re Pr Name bate <br /> Time ANA <br /> �} Time <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS N OF C ODY WITH INVOICE AND RESULTS <br /> REV 4/1193 — <br /> SHELL 01L COMPANY CHAIN OF CUSTODY <br />