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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date I - <br /> RETAIL ENVIRONMENTAL ENGINEERING-WEST _ _ Serial No –_ Page �ot <br /> Site Add{ 6, , 1 Address r�c�� r — - Analysis Required LAB <br /> WIC# , <br /> CHECK ONE(i)BOX ONLY CTrDT TURN AROUND TIME <br /> Shell Engineer ho No ' 7 G W Monitoring ❑ 44e1 S � � /�—1G���I ❑ �tLIN-,,j wkLOSN� 2a Hours ❑ <br /> ti SRe Investigation <br /> ax# ��� t I�l 49 hours ❑ <br /> Consultant Name$Address a Soil ClassdylDisposal ❑ 4442 ��{{ <br /> I <br /> cm Water 15 days %normal) <br /> IL-C� { ��� CtassdylPlsposal ❑ 4447 Other <br /> El <br /> onsultant Contact h tZ Il ' .— <br /> pf c O I- SoWAIr Rem or Sys <br /> L l �� C aX u� �� M W NCa 0aM 4452NOTE Noldy Lab as <br /> Comments[ d Q o a ul Rem or Sys [] a453 soon as possible of <br /> T p tl O 24I4e his TAT <br /> Otherin <br /> C] <br /> Sampled by U f0 m ----- -- — _ `_ t <br /> , Z— rx�r Co Co !o n UST AGENCY S ;05 CD <br /> a. <br /> LN <br /> Panted Name �aL o_ °U. m o O _ ° `� MATERIAL — SAMPLE <br /> X -0m f0 t° CONDITION/ <br /> Sample ID Date Sludge Soil Water Air ontsNo t CL n j ¢ a DESCRIPTION COMMENTS <br /> AF <br /> Daley r � Pr Dale <br /> Time shed By(sign Printed N T <br /> Tlme <br /> u!s d B,tPgnat Prt , Daley yy- Rertelved(signature Prlri�Name` J Date Jr r <br /> /7 — — TimetT }` � r 1 1 f r + I I l f I I E I I t I I i1 p11+ 1 J — Time r _ <br /> Relinquished By(signature) Printed Name Date Received(signature) Printed dame Date <br /> Time Time <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS <br /> REV 4)1191 SHELL OIL COMPANY CHMN OF CUSTODY <br />