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PARKER <br /> F CUSTODY FORM <br /> Environmental services CHAIN O <br /> 190 East 7th Street <br /> Pittsburg, CA 94565 ^ r 3 D3 The C V 5-�O m e-r C a I-, <br /> (510) 439-1024 Site # 6 <br /> Fax (510) 439-2566 Location: '390 NORT-F} A W ST. MAV-ia—CA MAV-Ta-CADate Z - 2 2 <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-g TPH-d BTEX 0 & G 8240 Metals (list) Asbestos . Other Remarks <br /> Mw- f x 3 x X MTt� 61810 <br /> 1� <br /> 61811 <br /> x y�9 <br /> Mrg�- <br /> .3 � x 61812 i. <br /> M - q3q/ MT6E fi t813 <br /> ' 1 <br /> . S <br /> Sampler Name (Print) M a tSam !er wp P Signature <br /> ngurshad <br /> Date andTime Receiv B Date and TISampling Site Sketch <br /> Z2 L6.25 Date and Time eceived By: Date and Time 3 2- <br /> Relinquished <br /> . N � <br /> Relin uished B Date and Time Recelved B : Date an <br /> d Time <br /> q Y� Y <br /> Rellnquished By: Date and Time Recelved By: Date and Time <br />