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rmmmmm MMmm MIMI M mm M M MM <br /> Phone('J16 2 21 lilSend results iu <br /> 1 <br /> ;.K (916)786-78311 L AEGIS Environmental Consultants, Inc, Aegis Environmental <br /> la7 Sample Identification/Field Chain of Custody Record sol Rrvprside,Suite C <br /> Roseville,CA 95678 <br /> (S6-It G' 13 2 Sri& m /� Thor Shell Protects Only - <br /> Sue Address ` WIC f'" ��' <br /> AEGIS Project# AFE <br /> Shipped Ry J <br /> CT/DL. <br /> Shipped To yf 1 <br /> Shell Engineer; <br /> Protect Manager l -r <br /> Hdcdrdous Materrdls Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field 1D1i Date Twoe Containers Re uired <br /> o' /"w-//� 7C / fes/ 8�s r�k �f Bray <br /> ro /IA1—/1J' <br /> 20 b <br /> Sampler(s)(signature) ,� r <br /> Field 1D Relinquished R (signature) Retelved R (signature) Dale/Time Comments <br /> ot4vr— __. ?/In <br /> Scaled for shipment by (signature) Date/rime FIAVlo Shipment Method- IVAr <br /> Received for Lab by (signature) Dateffime ? / / / ^Comments <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> Whit/Orrprn J Y11140%V11 kb(14111V 1,1110 do ropy <br />