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Phone(91602 2110 Send results N <br /> FAX (916)786-7830 AEGIS Environmental Consultants, Inc. O ;o Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record � 1050 Melody�e,,cSuui9 160 <br /> I _ 5678 <br /> lavrshell Project'.Only <br /> Site Address r �""t WIC <br /> AF <br /> AEGIS Project# - JCt E <br /> Shipped By �1 -- CC/DL <br /> Shipped To L Shcll Engin <br /> Protect Manager. is LLQ�'_ - --- ---_-- Hazar ous Materials Suspected') no) <br /> Sampling Sample No.of Analysis <br /> Point Location Field 1D# Date 7 ype Containers Required <br /> tA:k CA- ki�k? Lj A-V 44Q &TF*- <br /> Sampler(s)(signature) L ' <br /> Field <br /> ID Relinquished B ( tgnature) Received By(signature) DalelTtme Comments <br /> `� Ur NCs <br /> Sealed for shipment by (slgnatu _ L U"- Shipment Method <br /> Received for Lab by {signature} Dale/rtme Lt,; c Comments <br /> i <br /> Reteivmg Laboratory: Please return original Form alter signing for receipt orsamples. <br /> WWL/Ongm.d YCIIuW1t rh Copy I'LnkA do Copy <br />