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i <br /> ► '�, SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale- <br /> RETAIL. ENVIRONMENTAL ENGINEERING -WEST Serial No ' Pago sof � <br /> s to Address <br /> E `,� �] Analysls Required LAB: 5E12V of k <br /> ICS: CHECK ONE(ti BOX&&Y avuT TURN AROUND TIME <br /> Zo�•`75��� � so� <br /> �! a W 141e1110r1110 ❑ uel <br /> SF911 Engineer: <br /> No 7 b)l � 41 h <br /> Ll N 0 S,PI—wL k1axil7 - eke In"814e11en ❑ 1111 Ie hms <br /> O <br /> Consu and Name&Address:'Fk � salclautya'polr ❑ ,.42 ❑ <br /> cli <br /> o Water lederJormer) <br /> LA S-Q- V tL . �Sta1� °° � � , Ctreally"spotel ❑ 1413 <br /> (Jon(atflidnt) n a : �11140 <br /> No : 8Z 2 l� *v somAir nus ere Orh.r!Sub 1-W& -FALAtjkl a ,1 Flo�9 D gyms ,� n esu r` ❑ aes <br /> o n0 t;.� HDTE Nally tab u <br />' r Commsn s: ti p , N r N Wada nein«ape looneeP"fromof <br /> ?? u O O '� N O e N K4463 2111!Ira TAT <br /> 2 Av) Other ❑ <br /> l same 97 y: <br /> CIS <br /> 0 o a 5 r- N C UST AGENCY-341 P <br /> PTlnledame;- -Md-L Wei 0u, III O <br /> -- �- m MATERIAL SAMPLE <br /> Sample ID Date Sludge sol) WaterA[T Nto 01 = _ � m E � �M � f)ESCplPTiON CONDCONDITION/ <br /> � � � � ►- 3 W �� 3 a � ENTs <br /> rl 50 t :9 <br /> I <br /> Ra leh BT(sign )� Jr PdNNa m Ng, fj W94 12�` flecetved(elgnaturo), Pr[nted Nome tale <br /> Time U� Time <br /> Rellnqulehed By(eignalum): Printed Name Date necetved(algnalure) Primed Name Dale <br /> i <br /> lime Time <br /> Relinquished By(elgnature) Printed Name Dale Ilec ved(eignalurs) Prinled Name Dale <br /> Time _ (, <br /> rhe <br /> THE 80RATOnY MU3T PROVIDE A COPY OF THIS IAI STORY WITH INVOICE AND RESULTS <br /> f <br /> �y r,`l � �ilrlr nor ^n. •• ,.rr Ini.." <br />