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Dale:qP SH SHELL COMPANY AIN OF CUSTODY RECORD �( <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No- Page I of <br /> Site Address: LAB• <br /> � ��� �� • Analysts Required <br /> `C$ CHECK 014E(1)SOX OIILY CT/CT TU RPI AROUND TIME <br /> S C vd�e l C W Monllorinp ❑ 4J61 ❑ <br /> 21 horn <br /> Shell Engineer: c-rr I.�c� Phone No : - la SM.Inr.sllpadbn 141E <br /> Y 16 hours <br /> Fax #{' S 5i <br /> Lf — D3 (/1r� ❑ <br /> ` 7+ N SoR CloseRy/Dirporal ❑ 1412 <br /> Consultant Name &Address: '2.'rO 2r-k(V\ 5 0 16 darr fllormoq <br /> /� 6-1'C4_ 1 Shc/LG9Vl/ti0� Wnl.r 1112 <br /> [SVA V l o Chr�lfy,Clrpo,al ❑ 01h.r ❑ <br /> Co sullanl Conlact: Phone No : '7o 7- = 11 ca �4 SoKIAUR.enesSysCA ❑ <br /> co cd v a M 1452 I40TE Nollfy labor <br /> Fax VtSl` V! Q Wal•r k•m orSy� n or Pouibl•el <br /> Comments: LU 0 o a M ❑ 415] loo21/Id hit UT <br /> W Z OIh•r ❑ <br /> Sampled by. N a 0 ~_ <br /> N <br /> v, °a a `� c UST AGENCY- ay. o �'� <br /> rO co _< O 0 1�. N O N <br /> Printed Name. o � n ti � = o � L+1 o q d a MATERIAL SAMPLE <br /> a CONDITION/ <br /> No of x w o o o 2► o DESCRIPTION COMMENTS <br /> Sample ID Dale Sludge Sol] Water Air conls h c'-o } I- <br /> -216 <br /> — <br /> U Q U <br /> d- <br /> Sample <br /> 5 -2 6 5 , <br /> .000CUST;DIS414TACI ❑ N I NTA 10T❑ <br /> PDS MPERA RE <br /> Prinled Name Dale <br /> Reil is (signature): Printed Nar]Te }� Dale (�" Re/��Ived(signature), $�Kl_ <br /> [� LSf,�C7Tav''ti- dime T L= /v � e f Go <br /> 1 s od c nalure)• _ Prinled Nome• Dale ved (signature Prinled Namv Dale / <br /> q 9 Tlrne .. i]me <br /> Rsllnquisfled By(clgnalure) Printed Name. Dab Recelved(signs e) Prinled Name Dane <br /> Tirne Tlmo <br /> TII I$gJAIN OE CUSTODY WITH 114VOICED R SULTS <br />