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dFPhone(9,4F21 17 Send results to <br /> F�X (910)780-7830 AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> Sample Identification/Field Chain of Custody Record 1050 Melody Lane,suite 160 <br /> Roseville,CA 95678 <br /> SiteAddress I"r <br /> �� oo ,A For Shelf 1'ro�eris Only <br /> GI <br /> AEGIS Project# 0 WIC <br /> C� AFE <br /> Shipped By Cr/DL To AJ _ <br /> Shell Engineer <br /> Pro}ecl Manager r Haiardous Materials Suspected?(yes/no) <br /> Sampling Sample No of Analysis <br /> Point l [/ Location J� Field/1D# Date T e Containers Re uired <br /> e BS t ♦ Vr/^ t/ <br /> 0-0 7 -miv-91 305' l S-$ SOI L- <br /> ph <br /> ffl I SO So it 11-IS-'91 SOIL 2* r r r I <br /> �ilZ+/9� O�Yo <br /> Sampler(s)(signature} 012 J <br /> Field ID Reltn wished y{si nature) R slued Q (si nature) Date/Time Comments <br /> �W vi f tics) <br /> �il�4;r- <br /> Sealed for shipment by (signature;) Dateffime Shipment Method <br /> Received for Lab by (signature) Dalc/Tlmc 1/41/70 o Frey Comments k/ <br /> ,Q rJe S ell d '! <br /> Co �-� Z <br /> � 8 Q mn <br /> Receiving Labor dory: Please return original form after signing foreeeipt or samples. <br /> Whittiongin.d Yellow/1 A Copy 11ink/1 Jc Copy <br />