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* i ! <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECOflD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING-WEST Serial No _ page of <br /> Stle Address: ----- <br /> 7 700 More �aAd c7 S-��,r) Analysis Required � LAB• P <br /> WICK I Ck, i <br /> 4- 10-7 <br /> CHECK ONE I1180x ONLY CT43T TURN AROUNO ME <br /> She!}Engineer c� + Phone No -� -- -- <br /> 0w utonko,lno U 4481 — <br /> �c,re fl C cy-K Fax 0. U ske Inv"rlgation ❑ 4441 24 nous O <br /> Consultant Nam-9-8 Address F solCtaseaya"Mal ❑ 4442 46 haus ❑ <br /> 1�, o aF <br /> ST 1,�c ago w.wr l5days �o,r►al <br /> Crx�.rry/dapossr <br /> Consurtant Contect Phone No•$pp 13 4147 A � Dins, ❑ <br /> 0 <br /> Davi e C�fQ Fax 7���'� 5 g m nvi to �. o aµr"am a Sys 11 4452 <br /> Comments la N co N wars Rnaor Sys NOTE <br /> Noff L bags <br /> 0 I o a M Cl 4457 241461we TAr <br /> cwv <br /> Sample y• "t ] -�-- __— La Ln 04 _ ah•r fn V.ftx;,�"4na-144 <br /> _ UST AGENCY: <br /> Prfnted Name -Dc.,/) doh e S O o L c t: <br /> y .2 ° $ MATERIAL SAMPLE <br /> Sample ID Date Sludge Sop Water Air No of a: � � b in � � � E DESCRIPTION <br /> CONDITION/ <br /> toms in <br /> 8 a COMMENTS <br /> �P td <br /> 10 00;Lq <br /> — - � �I�O� Dir nk) n waTe� �► <br /> fi if qulshe 8y(slpnalura) P,lrlwd Nam Date 103-q_s deceived(signature) — --- Printed Name Data <br /> )p` uG'r1 O►tt5 Time _ _ Tims <br /> Relinquish By(signature) Printed Name Date _ Received(signature) Printed Name - Dale <br /> Time time <br /> Fleiinquhhed By(algnature) Printed Name Date Receive gnalure) - r me a bate <br /> Time 5 <br /> tHE U'IBORATOnY MUST PROVIDE A COPY OF TIiIS�1111N OF 11STOflY — " _ Time 155(0 - <br /> _ V1111 INVOICE AND RESULTS <br /> iiCV IiiR1l <br />