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• Send results to e <br /> Phone(916)0-110 Environmental Consultants Inc. <br /> AEGIS Envrl � Aegis Environmental <br /> FAx (916)786-7830 t <br /> Sample Identification/Field Chain of Custody Record 1050 Melody lane,Suite 160 <br /> Roseville,CA,95678 <br /> 1 <br /> For Shell Projects Only <br /> Site Address. - <br /> AEG1S Project a._ Z -- A E <br /> Shipped By eV9f&i CTNL <br /> Shipped To Shell Engineer <br /> Protect Manager Hazardous Materials Suspected?(Y o) <br /> Sampling Sample No.of Analysis <br /> Point Location Field IN Date Type Containers Required <br /> - \ a — - Z W A r6 iZ Z t-� <br /> Sampler(s)(signature) <br /> Field ID Relinquished Vy gnature) P.,eceived (stgna r Date/Time Comments <br /> AALJ- <br /> --f N"-1 <br /> Sealed for shipment by (signature) L+. Datefrime ?" -�b Shipment Method L-/( 1 0 Acy, c} z— <br /> Received for Lab by (signature) Date/Time _ �� ��L- O Pbu Comments <br /> ReLervrng Laboratory: Please return original form after signing for receipt of samples. <br /> WNIL/Orngwal Yellow/Lah Copy PuLM de Copy <br />