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SHELL OIL COMPANY W CHAIN OF CUSTODY RECORD Date S i' - <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Sertat No Page 2 of 3 <br /> s <br /> Site Address <br /> Z <br /> 1 Analysis Required LAB 11-4ve), <br /> vAcu CHECK ONE 111 BOX ONLY C7rDT TURN AROUND TIME <br /> l c+44'6 0 <br /> O W Monlorinp ❑ 4481 <br /> Shell Engineer Phone No "yl 24 hours ❑ <br /> A� I— �i��!'` She Investlpallen �4441 <br /> Y Fax# Soll Claadly/Disposal ❑ 4442 49 hour ❑ <br /> Consultant Name&Address <br /> C3 Water <br /> N 15 days WINormall <br /> I �Y�Ir 1 �� I S ✓!f �P X ClasdlrlDlsposal ❑ 4443 char ❑ <br /> M S—U t5066-—nI act Pho e12 So11Atr Rern.or Sys <br /> /� 1! l yz_ l v ^ m W O a M ❑ 4452 <br /> �c 7��`-� �r G� •b-c..+'1 Fax it 766-IT,?o 1 000 ca NOTE:No1Ny Lab as <br /> L7D 1n Wader Rem or Sys soon as possible of <br /> Comments 0. Q 0 a M ❑ 4153 24148 hrl TAT <br /> 0 0 <br /> Q <br /> _ v OtherCD <br /> ❑ <br /> Sampled by to in N in <br /> w m a m ? UST AGENCY f <br /> Printed Name �-/`��L I a � O w m o� S �' $ c � V, SAMPLE <br /> �. rn '- ILMATERIAL <br /> Na of H E E CONDITION/Sample ID Date Sludge Soil Water Air conte m 7 DESCRIPTION COMMENTS <br /> - <br /> /74 <br /> �i�-wry <br /> Rohn slpn re) Printed Nim Date y-41' R ceiv {$i lure) Print me Dale <br /> Ti <br /> ul By(pignatural Prt1 Name <br /> �1 /l/� —Data R ed(alpnalur Printed Name Dale— <br /> Time C� Time <br /> inq:Ishe tslgnalure} Printed Name Dale ecel (signature P ed f'�am y�,, Dale <br /> Time 7C J `O I1/{�, "— Time <br /> — THE LABORATORY MUST PROVIDE A COPY OF TPI1S CHAIN F C STODY WITH INVOICE AND RESULTS — <br /> REV 4/1193 SHELL OIL COMPANY CHAIN OF CUSTODY <br /> I <br />