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Phone(916)782 2110 Send results to: <br /> FAx (916)7822110 AEGIS Environmental Consultants; Inc. Aegis Environmental <br /> 01 Riverside,Suite C <br /> Sample Identification/Field Chain of Custody Record SRoseville,CA9567s/�/ <br /> For Shell Pro ects Only / <br /> WIC: 2OS� <br /> Site Address: AFE: <br /> AEGIS Project#' <br /> CT/DL: <br /> Shipped By: <br /> �y 15 <br /> Shell Engin <br /> Shipped To: a Engineer � <br /> Project Manager f rk y �uf6`r Hazardous Materials Suspected. (yes/no) <br /> P g Sample No.of Analysis <br /> S point Locatiorrr - Field ID# Date Type Containers Re uired BiAss 403/ay .o w,/ / 111 Brat', <br /> e-l/ /o GV Lf 577 9///m � <br /> a- 1, 2o/1 0P3457% <br /> l5 <br /> a-► 3 M 3 � <br /> t <br /> Sampler(s)(signature) <br /> Field ID Relinquished By(signature) Received Ay(signature) Date/Time Comments <br /> Scaledfor shipment by: (signature) -� "_i <br /> Date/I ime: �d 9O Shipment Method: �o f 14, <br /> �. >iw fit^r i2£(V D >£e t L r-D Date rime: 3/%L�/o r/. 3� Comments: <br /> Received for Lab by: (signature) — <br /> e Receiving Laboratory: Please return original form after signing for receipt of samples. <br />