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Phone(916)782 21to !AEGIS Environmental Consultants Inc• Send results lo: <br /> FAX (916)786-7830 Aegis Environmental <br /> Sample Identification/Field Chain or Custody Record 801 Riverside,Suite C <br /> p Roseville,CA 95678 <br /> For Shell Prujeds Only <br /> Site Address ' WIC -- <br /> AEGIS Project# 1 sAFE _Shipped B -� `=--- CT/DL. <br /> Shipped To _ Shell Engineer. 'r f <br /> Project Manager. �- ► t •� _ HmFdous Materials Suspected?(yes/no) <br /> Sampling Sample No.or Analysis <br /> Point Localum Field ID# Date 7 Tpe Containers Required <br /> V <br /> r <br /> Sampler(s)(signature) k3' ► r ..% a C� <br /> Field ID Relin uished B (signature) Received B (si nalure) Date/Time Comments <br /> 4 1P <br /> Sealed for shipment by (signature)_ ' E - �` • 1 ( Datelrime f' �+ '- �� Shipment Method { <br /> Received for Lab by (signature)-- DatelTime Comments. <br /> i <br /> F <br /> Receiving Laboratory. Plerse return original form alter signing for receipt of samples. <br />