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p:ione(916)21 lt} "Utao. <br /> o. <br /> 17 <br /> FAX (916)786-7830 AEGIS Environmen 1 Consultants, Inc. Send resAegis Environmental <br /> Sample Identification/Field Chain of Custody Record 801 Riverside,Suite C <br /> Roseville,CA 95678 <br /> Site Address - 6131 PO C / >r/ l/,c MIC S 14)6 W rO AFor Shell Projects On! <br /> (A J _ 1 4 r5 (, <br /> - — <br /> AEGIS Project g. S v — o L U we/1l . 1 1"/ ' AFE <br /> Shipped By l Jt <br /> CT/DL, i <br /> Shipped To. Shell Engineer a 0 k t l! k c 6 j•J S � <br /> Project Manager— 4,j - <br /> Hazardous Materials Suspected?(yes/no) <br /> Sampling Sample No.of Analysis <br /> �} Point Locathm Field ID# Dale TvK Containers Required <br /> b - sZjT r <br /> 6/ .1/ Tf 'J/ <br /> ,� w- Com✓3 / / �i��c <br /> du 7 t3 s 14 r <br /> c -rr/lEr <br /> Z44t- 1 <br /> i <br /> Sampler(s)(signature) <br /> Field ID Relinquished B (Signature) Received B (signature) Date/Time Comments <br /> MLJ <br /> /I A4 <br /> t <br /> /f <br /> Sealed for shipment by (signature)x f Date/Time , Shipment Method <br /> k - <br /> Received for Yb by (signature) Dalen rme Comments <br /> 1 <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> WhWOnginA Yellow/t ah Cupy Pink/17-de Copy <br />