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Send results W. <br /> Phonc(916)78221111 AEGIS Environmental Consultants, Inc. go .ens ronmen al <br /> FAX (016)79&7830 Roseville,CA 95675 <br /> Sample Ydentification/Fietd Chain of Custody Itecor <br /> For shell Projects Only <br /> slat k h _ C4 WIC. C`u 7494- �bOS/ <br /> N/7 <br /> Site Address: __ AFE: <br /> AEGIS Project/: — — CT/DL:a NA <br /> Shipped By: Shell Engineer r.Rl/ inion <br /> Shipped To: Hazardous Materials SusPwZV(yes,fO C <br /> Project Manage Sample No.of Amrysis r -7 <br /> T Containers R edb57 <br /> sampling PointLocation Field IDN Date / <br /> 007 S <br /> 007 -7 <br /> l/ <br /> 0075 a <br /> r� S n L - 11 007 a 8 z� <br /> N <br /> Al W- NCR' car 1_ eo 7 �g3 <br /> Samplcr(s)(signmure) Dateffime Comments <br /> Field 1D, <br /> R is uished B (st nature) Received B (si nature) <br /> Sealed for shipment by:(signature) Date/fimc:� 3/ 4 s2,�Shipment Medrod: C!7U41 <br /> l7atc/t'ima () Coomments: <br /> ..�ejvcd for lab by:(sigrsatum)� � �L/�T� -- <br /> � <br /> Receiving t borrlory: Please return Original form arler signing for receipt of samples. <br />