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Phone 916782 2111} <br /> ( AEGIS Environmental Consultants Inc. Send results to: <br /> FAX (916)786-783[) � Aegis Euviranmrnt;ll <br /> Sample Identification/Field Chain of Custody Record 801 Riverside,Suite C <br /> Roseville,CA 95678 <br /> ��/� �ET� / v� For She]] Projects Only <br /> Site Address: i 7Ti�Sc/ y/ 5 G. acv G _ W <br /> AEGIS Project 8: z� - 0 9 9 AFE: <br /> Shipped By: / CT/DL: <br /> Shipped To: CC/--7-5 - S Shcll Engineer: <br /> Project Manager t ; Hazardous Materials Suspected? (yes/no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field ID# Date Tvee Containers Required <br /> /Y1 cn2� 04170 S 9 a ! I <br /> 7—P/-/ 6Rs ,rey- <br /> 'J c� -r3L3b. <br /> 1 s rlI A- �-- I � '7 ��3_°1 � i w/�iC2 3 D 9Z <br /> I ' <br /> Z W _ 7 <br /> S M Lj <br /> �J -41 <br /> f <br /> Sampler(s)(signator ir/�ir � „ <br /> Field ID Relinquished B (signature) Received I!y(signature) DatelTime Comments <br /> i Sealed for shipment by:(signatu f ~ Dalefrime: ' 9,_Q0 Shipment Method: <br /> Received for Lab by:(signature) Dalefrime: T[?y�l�/� �7'yv Comments: <br /> --� r q j <br /> Receiving Laboratory: Please return original form after signing;for receipt orsamples. <br /> While/Original YCIIoW/-ah Cony Pude/File Copy <br />