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Phone 916 78150 nsultantsIncZj Send results to. <br /> FAX (916)78(WO AEGIS Environment o , . Aegis Esinmental <br /> Sample Identification/Field Chain of Custody Record 801 Riverside,Suite C <br /> Roseville,CA 95678- <br /> Site Address (aLJ� p t�� �NL -. �" eA . For Shell Projects Only <br /> w1c -7-04 7s2S'n c <br /> AEGIS ProleC #. —�Z� ,� 31 - dpi"" AFE <br /> Shipped By l�. - CT/DL SOJJ <br /> Shipped To V� Shell Engineer: <br /> Project Manager_ .4 ' C� Csa Q.r Hazardous Materials Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field IDIS Date TIRe Containers e1 Required ��m <br /> J <br /> AJe--- WW- amoodw L�� <br /> /( . 30 1n_ PIT!,'e", <br /> rampler(s)(signature) <br /> Field ID Relin uished a (si nature) Received B (si nature} Date11'ime Comments <br /> 7 <br /> Sealed for shipment by (signature)_L _ n r Datetrime. Shipment Method. <br /> Received for Lab by (signature) Date/Time 9a/J o Comments. <br /> Receiving Laboratory. Please return original form after signing for receipt of samples. <br /> WhuclonpnAl YcHowlt ab Copy Pudc/tvle Copy <br />