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PARKER <br /> Erivironmental Services CHAIN OF CUSTODY FORM <br /> P. o.. Boz 8067 <br /> Pittsburg, CA 94565 =�� . CITY OF LODI <br /> (925) 519-7782 Stte-L4 am e. CORPORATION YARD <br /> Fax (925) 473-0784 Location: 1331 SOUTH HAM STREET; LODI, CA Dare AUGUST 1, 2002 <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-g TPN-d BTEX O & G MTBE Metals (list) Asbestos Other Remarks <br /> T&L <br /> iiT <br /> Sampler Name(Print) {r,i. rC .% _ Sampler Signature <br /> lin shed By; Date and Timeive B� ate and Time ;Sampling Site etch , <br /> Relinquished By. Date and Time Recei'ved By: Date and Time <br /> Relinquished By: Date and Time Received By: Date and Time (73 <br /> sF " Relinquished By: Date and Time Received By: Date and Time <br />