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Phone(91 #211 J i , , "� Send results <br /> IS nvironmeal Consultants Inc. <br /> FAX (916)786-7830 � �� 3 '��� 7 Aegis Environmental <br /> Sample Identificdtion/Field Chain of Custody Record, 801 Riverside,Suite C • <br /> OVIRUNNIENTAL HEALTH 11Roseville,CA 95678 <br /> t <br /> PERM ITISERV(CE� 0i <br /> l f For Shell Projects Only <br /> � !/- 1 <br /> 16l� i OY� �� Y'T��7 ��I/ <br /> Site Address WIC <br /> AEGIS Project# `)U AFE <br /> Shipped B 'y�"r a CT/DL " <br /> By r <br /> Shipped To f L T Shell Engineer <br /> Project Manager r t h"'�'r Z } Hazardous Materials Suspected? (yes/no) <br /> 4 <br /> Sampling Sample No.of Analysis <br /> Point r, Location Field ID# Date T e Containers Required <br /> T �tt ar <br /> /19 <br /> r� ( 4i6i e-r D) <br /> (4 1,711 +��;, art n, ip. <br /> ,1 <br /> lrod <br /> Sampler(s)(signature) <br /> Field ID RReelin wished B (signature) Received B (signature) Date/Time Comments <br /> Sealed for shipment by (signature)_ al /r fill14 Date/rime Shipment Method /VC � <br /> Received for Lab by (signature) t t CL Date/Time L /fComments- <br /> ZI—A ►�`> r esus • 6 <br /> - ��O <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> White/Onginal YC11UW/1 7h Copy 11inkA i1c Cly <br />