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Phone(916)78..2l Ill Send results to <br /> FAX (416)786-7830 AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record , !lilt Riverside,Suite C <br /> 9 Roseville,CA 95678 <br /> E � G L, � Nor. Pro}eds Only <br /> Site Address .- �� ��� ��� �`Crt� , WIC <br /> AEGIS Project# AFE <br /> Shipped RY CT/DL <br /> Shipped To ti C R Vft Shell Engi r <br /> Project Manager Wit_ t ��: 11�a ���ci�r� �1 1'?fr1 c /�_r }{ ous Materials 5uspccted�(yes/no) <br /> Sampling Sample No or Analysis <br /> Point Loeation Field ill# Date ] /PC Containers Required <br /> VIA C - . f^' � <br /> ,. <br /> iM <br /> Sampler(s)(signature) l►- t't1r �1UL C ��� <br /> Field ID Rehnquishe Ity(signature) ReiLerved By(Signature) I Date/71me Comments <br /> 131 <br /> ` c <br /> Scaled for shipment by (slgnaturc l 1 �� Uate/l unc ` �� t Shipment Method PLC <br /> Received for Lab by (signature) 9-0 1 1�P_ Datefl imc (, - Li `�{�C' Comments ti`t Pb- 'b <br /> Rueiving Laboratory Please return original form alter signing for ref-eipt of samples <br /> Wh11L/0F1gma1 YcHow/1 ah co1,y Pink/1 i1v Copy <br />