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AIN <br /> SHELL OIL COMPANY CH OF CUSTODY RECORD <br /> 0 RETAIL ENVIRONMENTAL ENGINEERING - WEST Sena)Na: Pane of <br /> Site Address r Analysis Required LAB: ff nj t r;1ct_ <br /> r:r.i ► Pnt,;rt1(2. Avg ���tc ,� In, <br /> W I['# CHECK ONE 111 BOX ONLY CT/DT TURN AROUND T7MF <br /> SWI Engineer1'ttnne Nn IG Quartaly Monriortng 5461 24 hours I I <br /> 1 Site Inve511,94hon ( J 5411 48 hours ( I <br /> Consultant Name A Addrss��s -- ----- --_ Sal for disposal [� 5442 IS day: (Nnrtnal) <br /> f 111(jLh /`iWater for disposal [ [ 5447 Odw <br /> Consultant Contact. plim "a i �► Air Sample-Sys Oa<M [ ] 5452 - <br /> i '� r c y 7 gg 1. NOTE. Notify Lab as <br /> _.E>C i C� t\ f C jPJ Fox g �` 3 341 t� t Q Water Sample-Sys O&M [] 5453 soon as possible of <br /> CommentsOk <br /> Oil= [] 24149hrs TAT <br /> in 1, x <br /> SAMPLE <br /> Sampled I'McdNm ���v ti MATERIAL <br /> ° COMMENTS <br /> DESCRIPTION CONDITION/ <br /> NO Of I <br /> Simple ID Date Y Soil Water Air coontss pq E., <br /> -7 1baz .:z <br /> A, <br /> ) tb3t A <br /> ", d <br /> Pr,)gtegaeae, a = Date Z �s ( — --- — — Ptrned came - - - Due - <br /> V <br /> Relrnywshed By (signature) pruned name Dale. Rectsved(srgnaltre Primed name Date` <br /> Tutte Tent <br /> Reluputshed By (signalum) panted Mme a ecet (sugna=c) Pruned name Due <br /> Time tme <br /> THE LABORATORY MUST PROVIDE A COPY OFTHIS CIIAIN-OF CUSTODY WITH INVOICE AND RESULTS <br /> I mi Rcvibion Datc l(gISNI <br />