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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL. ENVIRONMENTAL, ENGINEERING -WEST Serial No page 4 of � <br /> site Address t� I Analysis Required LAB .�- <br /> oili, �..�,� _ • CLL 1�Ir~ , —— — <br /> wIC# <br /> + 1 CHECK ONE 11►R0I(ON[YJ C70T TURN AROUND TIME <br /> G W Moenonng I ! 446t <br /> Sh it Engineer Phon No L I24 hours I ] <br /> ' Soo Invesilgaoon I f 44411 <br /> ` ax # t I ( l 1 S sod ri ssny Dspos v 44az I 1 4a horns [ I <br /> Consultant Name & Address 44 L ,� :s t <br /> A ,+ O Wrier 75 days (Norrnrll <br /> L )i Ck,ssdy+Dlsl,u.,,I I I 44 i3 Other <br /> Consultant Contact t /Phone No 1 11 Sod,Alr Rem or Sys <br /> ijIL , _ y l �] O&M t�_415z <br /> � rtst L � 1FFF ` ax# lrtt )`[ 5� m xl <br /> - as <br /> Q) 0 1 Water Rem or Sys NOTE Noiss l e of <br /> i l4 Y Sawn h possible ul <br /> COlTlrneRlS [ ��� [� � N Q OdM I I 4453 2474Bh1s IAT <br /> =irL I �I1t L� ` lTI, !rJ r,l`JL11'` Lt C t ! co <br /> 2 p w T Other I <br /> Sampled by j }� ui in N u a m - - - <br /> \ o o m = t' N D ; J <br /> CD a, a ro o N = > UST AGENCY ~� �ti l! <br /> P' <br /> Printed Name j�-�C'' ,1�� I„ CL rL CD <br /> w O Q 0 m i <br /> w w m o = ° ±_ ° SAMPLE <br /> MATERIAL <br />� ---- -- -- - --- — -— No 01 z M iXil m CONDITION/ <br /> Sample? ID Date Sludge Soil Water Air a a- F— p m � y = � DESCRIPTION F m > 1— a a- COMMENTS <br /> r+ �` I r <br /> l 7 �''� ��•�,~�c`ale 1�r `t i <br /> y� <br /> rL <br /> �- 12t��l �` <br /> `,Ck1gLi y ?I/! -�tii (« c��•I ,� f `%/ �l4 - �'f� J <br /> ell Ishe By{sig a��ra)`r� Print ame n 1 Dath 4�2 k� Received(slgnatrue PrrJltg N�jme date E I ! i E �r <br /> V. Date= — t I A��'LIJ Tim Time <br /> l l � � � I ! 1 �I I � I I 1 t S � f � I( I I Il It <br /> 14 I l t Timer (! ! r f <br /> Relinquished By(signature) Printed Name Date Received(signature) Printed flame Date <br /> _ _ _ Time Time <br /> Relrnqurshed By(slgnaWre-) Panted Name Date Received(signature) Primed Name Dale <br /> _— <br /> Time Time <br /> _ THE LABORATORY_ _ MUST_ PROVIDE A_ COPY OF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS <br /> REV 41V93 - - SHELL OIL COMPANY CHAIN OF CUSTODY <br />