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I! WM IF ■nom <br /> I'IioAe(916f) '2221,10 Scnd results to <br /> FAX (916)786-7830 AEGIS Environmental Consultants, Inc. Aegis Frivironmenfal <br /> Sample: Identification/Field Chain or Custody Record 801 Riversadc,Suite C <br /> Roseville,CA 9S678 <br /> 4or Sbtll Profeck Only <br /> Site Address 4U �f�u/c yS u. r t zo �fr�'- 4 WIC <br /> AEGIS Project# o- a57 AFE <br /> Shipped By . AC61 S _ CT/DL <br /> Shipped To CG AS S Shell Engince <br /> Project Manager s /Ci.� Edhn� hazardous Materials Suspected') (ycsJno) <br /> Sampling Sample No or Analysis <br /> Point Location Field IDN Date 7 Ype Containers Required <br /> 5&CA ut — - — ( Pl- CA,!- t3Tea! G <br /> /4900 � � a� -- - <br /> L <br /> �Pa - 3 <br /> s - s <br /> Samplers)(signature) e., <br /> Field 1D Relinquished By(signature) Received By(signature) Dale/Time Comments <br /> I Z 7 9 AtA C Lltil JCf't. yip; /G u7 <br /> Sealed for shipment by (signature)- Date/I'mie o� Shipment Method QED" <br /> Received for Lab by (signature) / Date/Time Comments CUM��5 t T� S P3 l Z 3 <br /> Ir•1ku I CUM 0 5 i i_ 5 h 6 7 tri �u <br /> Reteiving l aboratory Please return original loran after signing for reteipl of s.unolc% <br />