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oc-�00017 RUSH - , <br /> PANG? <br /> Environmental Services CHAIN OF CUSTODY FORM v <br /> P. 0.. Box 8067 <br /> Pittsburg, GA 94565 • iZC3-,V-6i CITY OF LODI ! m <br /> (925) 519-7782 C RPOR ION YARD <br /> Fax (925) 473-0784 Location: 1331 SOUTH HAM STREET, LODI, CA Date , AUGUST 1, 2902 c <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH•g TPH-d BTEX 4&G MTBEMetals(list) Asbestos Other Remarks z <br /> ;n <br /> PHP <br /> n <br /> M <br /> Ln <br /> i N <br /> I <br /> � 1 � <br /> U <br /> A <br /> .xt tD <br /> Jfl1y <br /> i <br /> ' � C <br /> Sampler Name(Pr-fnQ f M AA Ts' Sampler Signature <br /> 7ins ed By; ate and Time ive 6 : ate and Time Sampling Site etch06-4-02, 2,311 14D <br /> 6 <br /> etinquished Date atnd Time Received By: Date and Time <br /> 44m <br /> Relinquished i3y: Date anct Time Received By: Date and Time <br /> 3 <br /> Relinquished By: Date and Time Received By: Date and Time <br /> V .. __... l w <br />