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i <br /> I <br /> s <br /> �.. <br /> Phone(4)E6)782 21 III Send results to: <br /> F.AX (916)786-783It AEGIS Environmental Consultants, Inc. AegisEnvlrenmen9il <br /> jSample Idenlilecation/I+ield Chain of Custody Record 1050 Melody Lane,Suite Ive <br /> Roseville.CA 95678 <br /> For Shell Projects Only <br /> Site Address: - <br /> AEG1S Project N:' d- -�� _ — -AF <br /> Shipped Ry' r <br /> Shipped To: '^`� <br /> SlreflEngincer. <br /> Project Manager_' �� %t�l _ Hazardous Materials Suspected?(yes/no) <br /> Sampling Sample No.or Analysis <br /> Point Location Field ID# Dale Tyne Conlainers Required <br /> SS°9/ <br /> I <br /> S" 0-Jj - 5 <br /> w 4 <br /> i <br /> Sampler(s)(signature I . <br /> Field IA elfin uis1. ll (s's nature) Re eived By(si gnalure) nalerfinte Comments <br /> 114;2114 <br /> 4,164 <br /> iA/Vwrs� 5 <br /> i <br /> Sealed for sbipmenl by:(signature Date/rime: 9110 Shipment Method: a <br /> Received for Lab by.(signal <br /> palcJl imc: o . Comments <br /> I <br /> I <br /> I <br /> j Receiving Laboratory: Please return original Form after signing for.receipt orsanlpies. <br /> I _ Whiid0riginal YCIIuwp.ahCtw Pink/1--deCopy <br /> I <br /> j 4 <br /> 4 C <br />