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M awl rr lll� r ® r. <br /> FAXPhon916 2110 AEGIS Environmental Consultants Inc Send results to. <br /> WrA <br /> FAX (9tb)78G-783f1 �� � Aegis Environmental <br /> Sample Identification/Field ield Chain of Custody Record 801 RwFrmde,Suite C <br /> 7 <br /> f ' Roseville,CA 95678 <br /> ,► <br /> f,� �� For Shell Protects Only <br /> Sile Address �-�4rr.i_ .LC zz cc fav WIC 2-05"- '?ZS oZ6 <br /> AEGIS Project o J0—o - _._ _ AFE <br /> Shipped By --= - CT/DL <br /> Shipped To. Shell Engineer. <br /> Project Manager HaLardous Materials Suspected9(yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field ID# Date TYPE Containers Required <br /> s r i 1 s r le C �I ts� 7/13 Sol �' �f " <br /> ,ic V\ <br /> Of Ap I -�V z A- <br /> Sampler(s)(signature) <br /> Field ID Reltn uished Vy(s. n ure) Received B (signature) Date/Time Comments <br /> — ,,t7loAa rG._. y 6 Gr <br /> Seated for shipment by (signdture) zlzip Datc/Timc FU Shipment Method. <br /> Received for Lab by (signature) Muc/Time 7Xe61ZfQ /VS- Comments. <br /> Retetvtng Laboratory. Please return original foim after signing For receipt of samples, <br /> WIML1 lripuo41 YcHow/1 ih Copy 11ink11 do Copy <br />