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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING o WEST Serial No , Page of ` <br /> Site Address Analysis Required LAB. :5f- l;Ct <br /> WICK l CHECK ONE(1)BOX ONLY CT1DT TURN AROUND TIME <br /> G Monitoring ❑ 4461 <br /> Shell Engineer Mine No ry <br /> \, ' f bi � SAO invesitallon EI 4"1 24 howl <br /> Pho5-&k ❑ <br /> Consullant Name&Address �} — soY cia..uyrol of O 444z <br /> C4 <br /> waver 156aya KiNormal► <br /> —�I;� S`V <br /> onsu � c�as.ural ❑ .+43 other Cl <br /> llant Contact hone No [4Z 2r. .. SoWAIrRom or Sys <br /> nn to O d M 4452 <br /> 140�-- Fax k:1 133a m ad NOTE.Notiy Lab as <br /> 0 p 440 wale(Ren or Sys soon n possible of <br /> pComments r E)v6T— N O&M K4453 2U4ghr& TAT <br /> Wx)m J+m �t�� Ln N ,� = m Other ❑ <br /> Sampled by` 00 m ato <br /> cn m UST AGENGY,S4U 1 <br /> Printed Name � � � '' � w � w 40 o � c ro MATERIAL SAMPLE <br /> >t 'a .'4 CONDITION/ <br /> Sample ID Date Sludge Sod Water Air No of X � ; ; E E DESCRIPTION COMMENTS <br /> conts <br /> 1ltg0 Ar^ <br /> ZJ1$J <br /> tile � <br /> s � <br /> L 4 <br /> Printed y <br /> Rel n ulhetf By( at. Printed Dete A * 7'7 // y { <br /> Date e <br /> �[r _C` �� ,� Time � •. �f I /�!�r <br /> Rellriglj5h9d By4sig e) -- Priale <br /> m �mg cr�a�re f Date r c' r R�vad Ipnalure � � Paw <br /> f 7U W��--J� Tuna t` <br /> �`!! {��/ _ Time 0,0.1 <br /> Relmquished By(signature) Printed Name Dale Received(signature) Printed �� Date <br /> Time Time <br /> THE LABORA TORY MUST PROVIDE A COPY OF THIS CHAIN-OF-CUSTODY WITH INVOICE AND RESULTS <br /> REV 41193 SHELL OIL COMPANY CHAIN OF CUSTODY <br />