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&A-IL <br /> ENVIRONMENTAL ENGINEERING-WEST I AL Senal No: Page IMW <br /> l <br /> Sl Address. Analysis Required LAB: � R�� � �� �.. <br /> 441rS �teS>{i+�lc. Qo �� ch <br /> WIC# S _... e CHECK ONE(1)BOX ONLY CT/DT TURN AROUND TIME <br /> Shell Engineer ,— Phone No$10 b8S 38 Quartaly Monitoring ❑ 5461 24 hours El <br /> Yl t c�. Fax# S a bt)S —try Sitc hnvcstigation ❑ 5441 46 hours ❑ <br /> Consultant Name&Address C Soil for disposal 5442 IS days 0 (Normal) <br /> AU, Z--JQ140,lINi"`�' - ��'a Water for disposal ❑ 5443 <br /> OSD 4A+-��- Z! e7 mit✓ LA Other El Consultant Contact Phone No 111, ?62- ¢t Air Sample-Sys O&M E] 5452 <br /> Irl 00 Water Sample-Sys ODM ❑ 5453 NOTE. Notify Lab as <br /> Fax#* C1 Ili..—; j-+7 N a scan as possible of <br /> Comments other ❑ 24/48 hat TAT <br /> J z <br /> 00 <br /> 00 Q ) �' MATERIAL SAMPLE <br /> Sampled By. —'� Q ` u A CONDITION/ <br /> Fruited Name O W£ti] 1� 11 �,��.1� DESCRIPTION COMMENTS <br /> Ip Date Soil Water Air No of � �,� 0 H <br /> ,.11Stinjjple conte <br /> W�T <br /> 4 <br /> s ytune) Pn nted name Date 1 s. Re v si a Print a Drtc d <br /> Time i; AA Time <br /> l afore) Printed n e DalclviL Receivod signature) Printed name Date <br /> irimc <br /> Relinquished By (signature) Printed name Date eceivod(st nature) Printed na�m..ye� Date Z/3)/91 <br /> Time ITune <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS C AI -O -CUSTODY WITH INVOIC9 AND RESULTS <br /> Last Revision Date 10/15/91 <br />