Laserfiche WebLink
Receiving Laboratory: Please return original form after signing for receipt of samples. <br />k/Fik <br />No. of <br />Containers <br />Sampling <br />Point Date <br />Sample <br />Tyne Field ID# Location <br />Date/Time Comments <br />mpler(s) (signature) <br />Field ID n uished B (signa)re) Received B (signature) <br />AEGIS Environmental Consultants, Inc. <br />Sample Identification/Field Chain of Custody Record <br />Send results to: <br />Aegis Environmental <br />801 Riverside, Suite C <br />Roseville, CA 95678 <br />Phone (916) 782 2110 <br />FAX (916) 786-7830 <br />70•6 SIS -9/0 l'i LI -1 0 Soli I rpm — /1.14/ ef- A isA Iv) <br />a-r- ex <br />S a -, o / IS 1) /0.0 c+. 1 5-/e/cs .., t, 1 I, <br />i zo. b ct. <br />S/S- ii 0 <br />., 70.6 -14-- sis-1.0 Jr it / h <br />518-1Z-/fg <br />1 <br />4 <br />io.b C+. se-i /fs et pi I g1 i <br />20° 4. se-17/10 41 )1 1 AI <br />Analysis <br />Re uired <br />eYS <br />13-A7/1) ,56-',5H <br /> if3r-iyi2)5B-IyitSI SS-1 0 ale, A-1---- A -Q{-0 /1// Zi -14 9 <br />c, l' <br />A ZziA) ' -,r 4.— 0 /6-3,, <br />Sealed for shipment by: (signature) <br />Received for Lab by: (signature) <br />ka : Icc <br />Date/Timc: Shipment Method: Ai t_1--cto-,4..CALA <br />Date/Time: //I-4 /90 id3o Comments: <br />ite 4.6.1td_ 127 ext't 1 <br />1/31g- bil4,42„,16,31Qi %ck-1,9-.4 1 ai <br />Shipped By: <br />Project Manager ke- Ahk-v-": <br />For Shell Projects Only <br />WIC: 204- 7 52 S4 - 2-9S <br />AFE: Ad" 4351r 4t- <br />CT/DL. Az+ zd" <br />S hell Engineer ater1,11 <br />Hazardous Materials Suspected? (y <br />Site Address: <br />Shipped To: Ai 19,50.c.i ,(1 L.,114,41- 07 <br />AEGIS Project #: S5- oy-7 <br />411,r5 tiv • 6W-1 •