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w <br /> ►1 <br /> , <br /> Environmental Services CHAIN OF CUSTODY FORM . <br /> P. O. Box 8087 <br /> P€ttsburg, CA 84585 Z„-(2 <br /> (825) 519-7787 ^�1�u�tS____� <br /> Fax (925) 4730784 Location: 3.7Date <br /> Sample Type Analysis Requested <br /> NUMMf Soli Water Time TPF€-g TPH-d BTEX O A O MTBE Metals(Nat) Asbestos Ofher Remarks <br /> F. <br /> o ��.. .._._. <br /> � :s __ -------3- -, 89545 <br /> oo 89547 <br /> �I'jK a <br /> Sampler Name(Print) ur�r- <br /> Sampler Signaturek1-1 <br /> --- <br /> to and Time "ved B Date and Time Sampling S Sketch <br /> Relinquished By: Date and Time Received sy: Date and Time <br /> AS 0&0 Mw <br /> Relinquished By: Date and Time�W d By: -Date and Time <br /> "a y Receive1��1DCf��y?�p* /, M?Rn1ATE <br /> I �$� <br /> 'Relingvlshed ay: Date and Time Received By: Date and Time <br />