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PARKER <br /> Environmental Services CHAIN OF CUSTO YFORM <br /> 41$5 Rialto Court t <br /> Pittsburg, CA 94565 o"Me tt. _ <br /> (510) 439-1024 Sitea -a r' P ir il <br /> Fax (510) 439-2566 Location: cj G PLA N 41- +U E -j- -_"T-7+'QA-C V Date 9 - 9-93 <br /> Sample Typo Analysis Requested <br /> Number Soli Water "Time T'PH-g TPH-d BTEX O & G 8240 Metals 01st) Other Remarks <br /> 2.,56 Y\ - <br /> I YC <br /> 01 <br /> .164 6 <br /> .._ <br /> wo <br /> EAD S 'ACE FN! O INUIS <br /> Sampler Name (Print) MA—i T L Sampler Slgrrature r ; <br /> U e � Date and Time Received Ry: to and Time Sampling Site Sketch <br /> ,L „�� r '6-9'9 J `'�, 3ji'� �f/ - <br /> Florin lshed By: Date and Time RecOved By: Date and Time <br /> 1 Relinquished By: Date and Time _ Received By: -Date and Time <br /> 'f''S. <br /> Relinquished By: Dale and Time Received By: Date and Time <br />