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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No 1 Page j of <br /> S le Address Analysis Required LAB <br /> WICp 20CHECK ONE(I)BOX ONIY CTIDT TURN AROVNL)TIME <br /> �•� �Z�_ ( �O°l <br /> OW Monroring ❑ 44$1 <br /> Shell EngineerPho a NO <br /> �?$-I t tc Sre Inve.ryallon ❑ 44H 24 howl El <br /> Ll N 1J w/�L�� — F x (o r S� 1 Z sof QualryrDlaaosw ❑ 4442 48 noun ❑ <br /> Consultant Name A Address*F Lof S� L k� ��� <br /> 15 days 40�lormaii <br /> W ter <br /> am <br /> co Crasally/Olspoaxl ❑ 4143 <br /> aper [) <br /> Consultant Contact0 sonar Rem or syI <br /> 416 H O&M " <br /> )S)' 52 <br /> NOTA Nally Lab a. <br /> 0 a u} Water Rom or Sys soon u posllbb or <br /> Comments C1 ,— �� o p� o O i M ❑ 4453 24148 he TAT <br /> rV i Co Other Elts CM a 1 _ <br /> Sampled by J Co '.a ( <br /> o :3UST AGENCY—S-" W =l P <br /> Cc Co <br /> a IA <br /> Printed Name C� w w [9 0 fn MATERIAL SAMPLE <br /> No of2 = a 1* I E DESCRIPTION CONDITION/ <br /> Sample ID Date Sludge Solt Water Air conte , a► r+ 9 COMMENTS <br /> a t- rs 8 CE <br /> 'A <br /> (!A On Co. <br /> I <br /> I <br /> R 11uis Br[al Print ai e p rte H (a tura Print d ame Dale Z <br /> 'L �� � l� l ,t _ C D Time <br /> ell uishe ( p ature] Prl t Name D-1) Zr14d[sign Printed Name Dale <br /> Tluiu T1me <br /> I uls ad B gnaturel Printed Name Date Ffecel=naturea Printed amen ID919 <br /> Time ---d (� Time <br /> THE LABORATORY MUST PROVIDE A COPY !14AHJ -CUS ODY WITH INVOICE AND RESULTS <br /> REV 411197 SHELL OIL COUPAW CHAIN OF CUSTODY <br /> I <br />