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�T_...r ...3 <br /> Phone(916)7822110 AEGIS Environmental Consultants* Inc. Send results Aegis Environmental <br /> FAX (916)786.7830 _ <br /> Sample Identif"scation/FieW Cham of Custody Record SRI Riverside,Suite C <br /> Roseville,CA 95678 <br /> Sill 4n �/� ��ell Projects Only �� ! <br /> _ ZU75zr <br /> Site Address.- <br /> AEGIS Project#: SO "�2-0 AS=E: <br /> Shipped By: A"I E5 CT/D1z -- <br /> Shipped To:. 5-of 066 10. Shell Engineer: <br /> Project Manager 8fe`''' (-q J Grp Fazrdous Materials Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field 1Dff Date Type Containers Re uired <br /> .61-6 M17,170 P's . BraX <br /> 6-7 -20 MY- 3/ab'/7e <br /> Q--7 V-5 -72 87f t\ Tn,, "/J / <br /> v. <br /> 5-S 25 LfSr BSIS 1\' .. � T /r,Br"-)( <br /> 6--eyrs VSA a,7f9 r��N, 9r'-x' <br /> V576, .8161' 3 <br /> Ln <br /> Samp:c!(s)(signature) <br /> Field 1D Relinquished By(signature) Received S ( ` 'tare) ; j Date/Time Comments <br /> Sealed for;ii;P.nent by:(signature)_ C ; Date/time: Shipment Mcihod: <br /> � ,tccci,•ed for Ub by-(signature) ��� i�(�ti•�u-a- SEAL E�7 Date/time O 3� Comments: <br /> Receiving Laboratory: Please return original form after signing 1')r receipt of samples. 3 <br /> ? `' whilcmFi incl YellowfLA Cupy,._ l'ivk/fdcCgTv <br />