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7o <br /> Phone( 782 211070 <br /> Send results to. <br /> FAX (916)786-7830 AEGIS Environmental Consultants, Inc. AeglsEnvimarnental <br /> Sample Identification/Field Chain of Custody Record 1050 Melody Lane,Suite 160 <br /> Roseville,CA 95678 <br /> For Shell 1'ra�etts Only <br /> Sale Address• I C�fL� STOGI/Tdd CAL _ _ WIC <br /> AEGIS Prolcct# d '" -0 • <br /> Shipped By_ E"bF►�' Aft_ <br /> /s —E� <br /> Shr1To Shell Engineer _ <br /> Plojecl Manager /aa;- ,O l __ _. Hazardous Materials Suspecied?(yes/no) <br /> Sampling Sample No of Analysis <br /> Point Location Field 1D# Date Type Containers Required <br /> -9/ t►iEfL 3 T Ps vE/ <br /> f^J�� Lir <br /> Samplers)(srgnature)l�AtNo V— ,. _ <br /> Field ID Relinquished f3 (signature) Received By(signature) Date/Time Comments <br /> lO:s�s <br /> �� r r �✓r r} NGS tJ''�7r� � ��L]/ <br /> Sealed for shipment by (s�gnatur r DatefTlme yr /G.ca Shipment Method th --t <br /> Received for Lab by.(signature)_ Datclrlmc / io a'VVV Comments <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> WhUtjOngmrl Ycllow/Lrh Copy Pmklt do Copy <br />