Laserfiche WebLink
,Phone(910 2110 <br /> Send results t <br /> FAX (916)7W7830 AEGIS Envlronmen al Consultants, Inc. Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record �� � 1050 Melody lane,Suite 160 <br /> Roseville,CA 95678 <br /> l'or Of Projects Only <br /> Site Address � '��'_ w N WIC <br /> AEGIS Project# j AFE <br /> Shipped By �L S CT/DL <br /> Shipped To Shell En r <br /> Project Manager ��— _ Ha ous Matcnals Suspcctcd7(yesJno <br /> Sampling Sample No of Analysts <br /> Point Location Field 1D# Dale Type Containers Re utred <br /> -L'izli <br /> 1 T 41 r?—/ <br /> 2, <br /> Lk <br /> vlt� V <br /> �^ IL <br /> Sampler(s)(signature) ' u� <br /> Field ID Relinquished (signature) Received By(signature) Datell'tme Comments <br /> tAtt7 <br /> Sealed for shipment by (stgna Date/ftm-e Lt Shipment Method t cc <br /> Received for Lab by (signature) Date/rime Comments -5- i AF <br /> Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> WhLIL10FISMA Yellow/l A Copy fink/}ilc Capt' <br />