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CHAIN OF CUSTODY RECORD Date: hf <br /> SHELL OIL COMPANY Serial N4• Page ai l <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST ' <br /> i � <br /> Site Address: 0�, Analysis Required LAS: <br /> CHECK ONE til a <br /> 1UIC D „������- `�`d`�`� �' (- Otu=C110T <br /> TURN AROUND TIME <br /> G w Monllorin9 ❑ 41i1 24 houn ❑ <br /> c5m�=, 1 3514!� F I <br /> Shell Enginee Phone No • Sllolnvodlpcllon ❑ u,) <br /> 16 houn ❑ <br /> 1/l C l/, Fax #: t S fl soflCloolly/DI►Potol LIt2 15do t rmnll <br /> Consultant Name &A dares : 27a Ps �5 P r <br /> cc Wolof <br /> C © � 5 t/ } clarrily/Ditpoeal ❑ ,443 Olhor ❑ <br /> C) <br /> SGL 7 lu <br /> co sulfar)t Contact: Phone O.: 7a7- = m SoR1AIrRomorsyt ❑ A,52 <br /> m O a M ROTE NaUfy lob of <br /> f�D Fax #t• 6 n Q 'n soon nt Possrble of <br /> Walai Rom or Sys ❑ "S3 24/16 hit 1A1 <br /> (' O a M <br /> Uo nls: <br /> T] <br /> O O o.O N M i Olh•r ❑ <br /> d a C ro- o k i2k i2 � 0 r 0 a >-o r <br /> Sampled by. �— 0 yr a o � o UST AGENCY:�a o� +�� L`� <br /> �� <br /> to ca <br /> A SAMPLE <br /> Printed Name- T S`�� w W `o Z �, o CL E MATERIAL. CONDITION) <br /> No or = w o m o Q o m O DESCRIPTION COMMENTS <br /> Sample ID Dale Sludge 5011 Wolof All conls Il a' m > , V Q U p• U <br /> to-cit <br /> Recelved(signature). Qlinied Name Dale Lr <br /> Rai s slgcature): Prin d Na e F� Daler2 (�j a. Z.:aD <br /> lima cab <br /> Dale Received(dgnaiute). Prinled Name Dale• <br /> I q� s gnat Prinled Name rime. _- <br /> G lir r Prinled Name Dote. <br /> Pllnlad Name Dolo Received(signature) <br /> Rel nqulshod 8y(:Ignaiure): Timo <br /> Time <br /> �} U 0 O O l O -CU OD W D RLS-Unuaanatw�or <br />