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i <br /> Send results to: <br /> Phone(916)782 2110 AEGIS Environmental Consultants, Inc. Aegis Fnvironmental <br /> FAX (916)786-7830 801 Riverside,Suite C <br /> Sample Identification/Field Chain of Custody Record Roseville,CA 95678 <br /> 4` f n For Shell Projects Only <br /> S II, <br /> 6151 InaCj f,L, Sf< n C�• WIC: Zat 75257 ot, <br /> Site Address: <br /> a —02,0 AFE: <br /> AEGIS Project#- e CT/DL: <br /> Shipped By: r5 �Se Ot _ Shell Engineer. <br /> Shipped To: <br /> ✓ o-- <br /> 64., Hazardous Materials Suspected? (yes/no) <br /> Project Manager <br /> Sampling Sample No.of Analysis <br /> p g Field ID# Date T e Containers Re aired <br /> Point Location TP CTB( <br /> 51, C%3 L(SZe 5,v-16 3127f90 <br /> S�5Le2 rn� ar�,r, T <br /> i � 33/2 71 <br /> �_ � •Zo ; BTX <br /> M1wV-A,.Z <br /> TPN, arEn �o�/ <br /> ldFPS+, arty <br /> TPN, arE>< Papg ` • <br /> Field ID Relinquished By(signature) j ReceivedBy(signature) Date/Time Comments <br /> -F/ SCGP <br /> "13 Not- t/err 12d <br /> Date rime: Shipment Method: (6atIe <br /> Sealed.for shipment by:(signature) c Li..;rZ,� L <br /> Received for Lab by:(signature)\'u ��2a Q 2 coo. -S£ lLfL: Date/rime• z SSU`' y_ Comments: <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. I <br />