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Phonc(916f 2110 , Send results to. 0 <br /> FAX (916,)786-7830 AEGIS Environmen al Consultants, Inc. �1�� Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record 801 Rive side,Suite C <br /> Rosev►I�e,CA 95678 <br /> �� r /' For Shell Projects Only <br /> GI �� �tirrJ+Z SclCri� C 71'�wl �^t�� 7`z.C,�� 1�7, WIC <br /> Site Address —. -----,! � .,__._ <br /> AEGIS Project 1i fC '�� AFE <br /> Shipped By ✓fir CT/DL <br /> Shipped To Ntr Shell Engineer <br /> Project Manager -Wel Al '' (e z - Hazardous Materials Sus ted <br /> pcc {yes/no} <br /> Sampling Sample No.or Analysis <br /> r� r <br /> Paint <br /> Location Field ID# 1Date Type Containers Required <br /> T fkrre�v! ]' / ' //P-11 ' I (Ate+CtD /IyG' �u� (a35 TPdfrc.s, d X 10-424/-' � t�t��rC-tl�) i1 r� TP8- (mss BrrsX 1 <br /> i1-Gns, BTF)r� 1 <br /> (A-tV-1C-t 0 \\ jL Fpd 6xs� �R�Ir, 1� <br /> 5 (Ai 04(--rp} " Y- rn#- 6-3, dr2x, le <br /> 7Pµ G,S, 8T`e•r, 1e4.1 <br /> Sampler(s)(signature) 'i'461C 47 ht 6, <br /> Field ID Relinquished By(signature) Received B (signature) Date/Time Comments <br /> SEC r�GC✓� �'�G4� ���'Z� <br /> Sealed for shipment by (signature) L-��( �i��.�� Date rime Shipment Methal. NG` <br /> Received for Lab by (signature) - Datc/rimc 8 Comments ,!/` -1i rr! •irc <br /> -- - -- -��l!k ,Ce ��a�►�s�l�. ����� � uS- - c�csc,,ss� a b��� <br /> - --- <br /> Receiving Laboralory. Please return original form after signing for receipt o>F Samples. <br /> Whna K)rn in d YAM%11 111 upV 1,101 1 Ili,COPY <br />