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i � ,C i S � � � iii 1 7C � <br /> Phone(916)782 2110 � � Scnd rc5utls to <br /> rAX (916)786 78311 Al,V IS Environmental Consultants, hic. Acgis I twirnminental <br /> Sample Idenlllicalion/Field chain of custody Record 1050 Mdo [Ane <br /> e,SuiteCA 160 <br /> 678 <br /> I,or Shell Pro}«Iti Only <br /> Site Address ' " . ' ( � 11 1 r' I -- WIC <br /> AEGIS Project ff ,1�� AVE <br /> Shipped By r i i 'T r _ Cl/DL <br /> Shipped To �' l I r ( 1 1 3 Shell Ehgincer <br /> Project Manager i r , _ IIaLudous Matcnals Suspecled► (yes/no) <br /> Sampling Sample No of Analysis <br /> Point location Field lD# Date 7 voe Containers Required <br /> I tic i 1 1 ► i ! % t I I - I � I <br /> 1 r <br /> 1 <br /> Sampler(s)(signature) <br /> Field ID Oehnyuished Ity(%ignalure) Received By (signature) DaIe/I une Comments <br /> A <br /> St'aled for%bipuiuil by (s,gnaiur(,) UalaI unc ! Shipnie nt Mc tlwd <br /> Rcc.LIVCd for Lib by (signalurc) 70FAk Canuiicnts <br /> Iii teivu►g I ahoratory I'liau•return original form atter%igning for reicipt of ~ample~ <br />