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Sampling Sample <br />Tvne Field ID# Date <br />For Shell Projects Only <br />WIC: 26 `i 76-2 51 2996— <br />AFE: la Ord- tk- <br />CT/DL• 465(51tul•-• ye-k" <br />Shell Engineer: 06.vve_l ivtS16.•A <br />Hazardous Materials Suspected? (yes()) <br />No. of Analysis <br />Containers Required <br />Site Address: <br />AEGIS Project #: <br />Shipped By: <br />Shipped To: <br />Project Manager <br />4.1316-- Wocli1_/60 /4,t_ <br />'in - CY -7 / <br />/5çv.(.1:01.$ . <br />kEr 1-&-k4-1 6407 <br />Mixt_ Aki.0.-L. <br />tion <br />Phone (916) 782 2110 <br />FAX (916) 786-7830 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 />56---7 /14 i i _ d.tfosi 4.- C.0 4- i 5B-1//4 1-2Y-90 s511 <br />1 -rpti-hx...,v-iiii i Iso ite <br />II 1-1 lb . a 4 56-7/(3 4 ii I <br />I <br />/ <br />zyc., 0 1, i h <br />/S. o ft 5g- 3/ c ii I) / 11 <br />s 46 - i/o <br />/ <br />I 1 <br />2°. ° <br /> <br />II Lt.° 4 se-4/6 il 11 ) 4 <br />S IS- 4/ C- <br />1- <br />) I I g- b h- 6(3-6,/c_ si il i il <br />ri- s/6 . <br /> <br />, 0,e, f+ .513...V6 I, il / <br />impler(s) (signature) <br />Field ID <br /> <br />Relinquished B si n ture Received B (signature) Date/Time Comments <br />03--vai s43-54.. <br />-3/c)513-yb, 5/3-6/6 <br />J. <br />Sealed for shipment by: (signature) <br /> <br />Date/Time: Shipment Method: (-0~1 t <br /> <br />Received for Lab by: (signature) Date/Time: Vi.c,/0,7 ic.5-3,3 Comments: .--f-4-0/ <br /> <br />ftio : 50„7 1 1 tS I CR, (". 'PAIL ICE, e_lta.* Ickei4 1-6P 1147 ex.v6i-vtAt ce-VV; <br /> <br />1,5 <br />Receiving Laboratory: Please return original form after signing for receipt of samples. <br />Mite/ I 3W11.: