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i i i ,i i i � � � <br /> Phone(916)4 .I m Send ruuFls to <br /> FAX (x)16)786 7830 AEGIS Environmen C n5lultants, In( . Aegis I nvirommuf it <br /> Sample Identilieallon/ ield Chain of Custody Record hill Riverside,Suite c: <br /> Roseville,CA 95678 <br /> hor Sb�ll I'roje�l� (hely <br /> site Address as E�, u1e y �. �� z �+��«•r— wle <br /> AEGIS Project# �'Q - 05 7 ATT <br /> Snipped By f1.61 s C1/DL <br /> Shipped To 6(_ 17S -V ri Shc,ll Gnylna <br /> Project Manager �566 /KIM,&e I larardous Materials Suspected') (yes/no) <br /> Sampling Sample No of Analysis <br /> Point I ocallon Field 110 Dale I vpe Containers Required <br /> I_pk 6n� <br /> L <br /> S <br /> Zee <br /> Sampler(s)(signature) <br /> 1•teld ID Relinquished By(signalure) Reserved Ily(Signature) 1).tic/I fine Comments <br /> Ul u4 lr T-r— <br /> Sealed for shipment by (signature)-&-, Date/lime "`1 �' ��+ _ Shipment Method <br /> Received for I ab by (slgn.dur-) Dat-/1 unL. _---- Colunl-nils CUM s c It 5 PA'S t Z 3 <br /> GJ ku I - (ON+,ao s r S1)6 <br /> Ricervurg 1 aboratory I'lvase rclurn original fol in tiller Signing for ruelpl of tiarsrpl-s <br /> Wh+lt/(hni,mal Ydluw/I .ill(nhy VinkIl 11L C iq)y <br />