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Phone(910 2110 Send results to <br /> FAX (910)786-7830 AEGIS Environmental Consultants, Inc. Aegis Envir+onrnentnl . <br /> Sample Identification/Field Chain of Custody Record 1050 Melody Rosevi�ue,CAi95te 678 <br /> 78 <br /> ZilkFor Shell Project-,Only <br /> Site Address Li, /� AN EL' <br /> AEGIS Project# 20- 017 AFE <br /> Shipped By /�F/_i�c ClypL, <br /> Shipped To �A-� _ _ ---- Shclt Engineer <br /> Project Manager 8p—Wry 6.dz4f£2 Hazardous Materials Suspected')(ye ) <br /> Sampling I Sample No of Analysts <br /> Point Location Field lD# / Daten T e Containers Required <br /> oN I r� , ! <br /> 3 v - � <br /> S Mss <br /> � Mv- <br /> M. 8 <br /> Samplers)(signature) <br /> Field ID elin tushed B (signature) Retety y(signatur ) Date/Time Comments <br /> z <br /> i.1SI � S 3 <br /> I <br /> Sealed for shipment by (signature) 6 — Daieffime Is Shipment Method 14b r►C—�i/.' _ <br /> Received for Lab by (signature) t' Datefrime OPO Comments <br /> Receiving Laboratory. Please return original form atter signing for receipt ofsamples <br /> Whiulongmrl Yellow/1 rh Copy NnkA ae Copy <br />