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r f <br /> Phone(916)7hc !I illScat results to: <br /> - i FAX (916)786-78:11 AEGIS Envirollllld'I ial-CtinsuIrants, IIIc. . -. Aegis Environmental <br /> r_ <br /> Sample Identification/Field Chain of Custody Record 801 Riverside,Snits C <br /> Roseville,CA 95678 <br /> For Shell l°roJrclsOnly.-_=: <br /> C G, .. O.1 __ <br /> Site Address: p�23 f-.O/ia-�o S _ wlC: �o7 -7 y-73g,W . <br /> AEGIS Project eT fQV2 AFE:--QTe 7 I V <br /> Shipped By: CT/DL: � <br /> Shipped To:T t -- Shell Enginccr: d,e2` a-. <br /> Project Manager Hazardous Materials Suspected?(yeoo <br /> Sampling Sample No.of Analysis <br /> Point Location Field IDN Date Tvoe Containers Required ' <br /> 73- <br /> I ` <br /> JQ 75 <br /> - 2 <<-1 Z -Ve-` 0 ► 7(0 <br /> i <br /> A <br /> Samplers)(signature) <br /> Field ID fy(sign4rej Received By(signature) Dalet'rime Comments t.r' <br /> -9 y SS'1 ter SS'11 � <br /> �i 46 <br /> Scaled for shipment by:(signature) Date rime: J` / � Shipment Method:_ f n&,At e j2 <br /> Received for Lab by:(signature) Dwe['imc: <br /> Comments: <br /> r. <br /> i <br />{ Receiving Laboralory: Please return original form after signing for receipt of sample. <br />