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%wo ,tLL. OIL COMPANY CHAIN OF CUSTODY RECORD Dalc <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Senv No 6,�/j�(c Page / of � <br /> Sllc Address• In/3/ _ <br /> Analysis Required LAB: �'E <br /> W1C �'�L� 1 2 n 1L CHECK ONE(1)BOX ONLY CT/DT TURN AROUND T1Mf. <br /> Shell Engineer _ I Mone No =/[r Quartaly Monilonng3461 24 haus/ <br /> aus <br /> /I Ui / �`'V ` _ �Fait M y � - - ---- Site Inwsligatxm 1 5441 48 hours <br /> Consultant Name dt Address Soil for disposal 5442 <br /> FfJIC'C�ftJ <br /> 13 sscx !�l7t'.Za \ 15 daysX(Niwmmll <br /> r Y7� water for disposal � � 5443 <br /> Consultant Contact + i4ioriC No /(� \ Air Sample Sys O&M 5452 Other i -- <br /> NOTE Nwify Lab as <br /> cal N 9� J��� .. Wain Sample Sys OkM 5453 <br /> r4 soon as possible of <br /> Comments <br /> a ,1 Other ( � 24148 hrs TAT <br /> N 7� <br /> o �l $ z <br /> 2 0o < , <br /> Sampled By I � 1 < < �o y SAMPLE <br /> `J A „ MATERIAL <br /> prmtcdName ZaAv6 f'DLEIL`r a DESCRIPTION CONDITION/ <br /> COMMENTS <br /> Sampk ID Date - Soil Water Air NO 0 _ <br /> A w <br /> AL <br /> _ re <br /> n1 <br /> - <br /> 4 <br /> / —_ <br /> J %)TP -io, 1 1:11 <br /> w <br /> clm9uts By (signature) ___ Rmle.,none <br /> �or•ty p,� trou.=y �260,4 <br /> -- Date f4 cc nature)- — - t name Uatc� <br /> _ Vine <br /> U By Irmte.r name Date R c si afore} Printed name Date- <br /> r Time <br /> e inywshe y (signature) name _ate ecriv (signature) Printed name Uatc '/ <br /> --- - ✓��r tii�J Time _ 4 ' Sl1 <br /> y <br /> s.i Rtvuum Date 10/15/9110/15/914LT`imcrL r2 <br /> TIJE LAIAORA"`lRY MUST PROVIDE A COPY OF THIS CNAIC(OF USTODY WITHNV <br /> IOICE AND REI TS <br />