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w w w w w w m, �f a.�� �• <br /> Phonz(916) 21 It) Send results to Ir <br /> f Ax (916)786.7830 AEGIS Environmental Consultants, Inc. Aegis Environment.d <br /> Sample Ment ification/Field Chain of Custody Record 801 Riverside,Snits:C <br /> Roseville,CA 9S678 <br /> For Shell 1'ro,}ee.f5 Only <br /> Site Address a z 09a) W, --t o,, Ac-LO 11,41466A fel-09 -7 wle <br /> AEGIS Project 11 R AFE <br /> Shipped By krbl S CT/DL <br /> Shipped To C 16 <br /> CAS —,'// 0 _ Sheil Engince <br /> Project Manager_�L.� Mm 111V b llacardous Materials Suspected?(yes/no) <br /> i <br /> Sampling Sample No of Analysis <br /> Point Location Feld IDti Date 7 ype Containers Required <br /> CV, 3 %PN oA11 <br /> 70 LULL w W. � kn � d 1ae -ITZl4 <br /> sN -3 <br /> Sampler(s)(signature) l - 146 <br /> Field ID 141inquisoed.By(signature) Received Ily(signature) DateNime Comments <br /> &L1rx , <br /> da <br /> ec-� <br /> Sealed for shipment by (signature) Dale/lime. /0' C4 Shipment Method �_ +0� <br /> Received for Lab by (signature) Date/Time Comments _S Tr SPA <br /> ost f- SPA -7 r,-Jw <br /> Rceervung Laboralory 1'lUse return original lorm alter signing for ret.tipt of samples <br />