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SHELL OIL. COMPANY �- CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING-WEST Serial No <br /> Site Address Page r?Laf <br /> ?�, !✓[� IAF- ---- --- ----- ---Anal of- <br /> Analysis Required — --- _ ~ <br /> y - 4 -- -- — LAB P o< <br /> Z` CHECK ONE 111 ONLY CTIOT TURN AROUND TIME <br /> _ 7 Z-L yl G-� -- -- --- ---- ---- <br /> Shell Engineer _ - Phone No �'!v- aw A1onlorlao ❑ 4461 <br /> ' t �r 7" �'f St•Inva.tlpalion R 4441 24 hau4 ❑ <br /> Consultant Name b Address - i _ Fax M $ul CI.,,u$V <br /> G�r L N rN 1 I 4442 4e hawa ❑ <br /> lG�!L:/`✓cr I 1 I/ ' n { a wawr 1 s dan f-1 IN«n.0 <br /> , _C�G 7 co <br /> Clx.l1r101.posal I 1 4447 <br /> Consultant act, ' - - War ❑ <br /> Phone o � �Qt 9oVAlr Rom or Sys <br /> Fax M cV O&M. n 4462 <br /> Comments �- -- to NOTE:Notly,lob u <br /> CV Q .�- wider R.m or Syssoon as poe bla d <br /> O W m O i AI El 4453 24!48 two TAT <br /> __ -- - w 3 Oth.r l7 <br /> Sampled by. _— -- - --- - r in ---- <br /> Q C3 co <br /> / - aa pa. p o >- UST AGENCY <br /> Printed Name �_"G t� ti err q. q, l li O © m -- -- - --- <br /> -- - Lu Lu <br /> E MATERIAL SAMPLE <br /> Sample ID ale Sludge Sad Water Air No of DESCRIPTION CONDITION) <br /> - -- --- — conte COMMENTS <br /> X, <br /> //Od <br /> Lj-21 <br /> Relinq <br /> By Islo tur PrinldN e DJJLSE�✓ Dal-/�Z 9 14ceivd( rfat a Pfl le ams Dala <br /> 7� ___ Time -L_ y��Ic14.1 Time <br /> el ule 8 gnalure) Prl to Mama -��— -- Date e7 ed{alq te) Printed Name Rate <br /> '' _ __ Tlrr'e .� �6 __ Time <br /> e qutsh (signature) Printed Name /� - Dale -_ Aecelve !1gnalure) -� - Printed'Name— '-` Date oZ <br /> --- ___ _ - _ ____ Tlma _ _� ��j = `��� 1211c Time lu <br /> — THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN F S D TH INVOICE AND RESULTS <br /> —-— —----------- ---- -- — - -- --- <br /> CI n r <br />