|
Date
<br />Sample
<br />e
<br />Analysis
<br />Reauired Field II)#
<br />Sampling No. of
<br />Containers
<br />Date/Time Comments
<br />.ampler(s) (signature)
<br />Received B (signature n uished B si nature
<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 />4 FAX (916) 786-7830
<br />Site Address: L, 7-1-1(— 114 L...._ I
<br />AEGIS Project #:
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<br />Sealed for shipment by: (signature)
<br />_ - Received for Lab by: (signature)
<br />1.1
<br />Date/Time: Shipment Method: •
<br />. , Date/Time: Comments:
<br />seiteee".: ret igin m 8,4 •--:gnin- --'san-'--
<br />vVhitc/t/ngtnal Tcilow/1 arr7-py rink/File 1-opy
<br />CT/D1..• ' I -1
<br />Shell Engineer. 1.L'r
<br />Hazardous Materials Suspected? (y
<br />WIC: r-
<br />AFE: J ' "
<br />For Shell Projects OnI v
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