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ll� I♦ 11th 1�111 !. L'- son" Lr <br /> ne(916)�110 Send results to C. <br /> �NY (916)786-7830 AEGIS Environmental Consultants, Inc. Aegis Envlronriental <br /> Sample Identiricationxiew Chain of Custody Record S�v 1050 Melody neF,.ke <br /> 95678 160 <br /> Rosi-_ ]For 11 Protects Only <br /> Site Address ��Vl t)c' �" 4 AC,L �>� 1A 'W l ��,� A _ WIC <br /> l <br /> AEGIS ProJcct# CC'C"('t 1 Al'E <br /> Shipped By ��t S "� l N _ _ � CT/DL <br /> Shipped To Shell Engi r <br /> Project Manager - 1.11 Lc-,V, ,n c ° Ha ous Materials Suspected?(ye o) <br /> Sampling ' Sample No of Analysis <br /> Point Location Field ID#1 Date 7 Vve Containers Required <br /> 1 HUT) <br /> C' C � i,7 t <br /> �M w 1 w- 2r, 5 W 1 2- <br /> P\ <br /> P\LJ - L..' -� <br /> ✓ti w -�v �1 t,c1 <br /> Sampler(s)(signature) <br /> Field ID Relinquished By(signature) Received By(signature) I Date/Time Comments <br /> !Z 5"c7 <br /> /t1 ry c-5 1 <br /> Scaled for shipment by (signalurc� t Datc/I ung c'-1 IZ ! � Shipment Mcthod <br /> Received for Lab by (signature) 1s�u,� w Date/1'imc ��z tZy z o A'v Comments <br /> Receiving Laboratory Please return original form.fitter signing;for ret.eipt of samples. <br /> un , ,n 1 v 1 11 1 e <br />