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PARKER <br /> Environmental Services C1HAIN OFCUSTODYIFORM X <br /> 190 East 71h Street <br /> Pittsburg, CA 94566 ,ion. -05 U-1-d <br /> (SiCi) 439-1024 a <br /> Fax (510) 439-2566 Location: Qob Sere +,P-ca Date ',TU A-7 1 qIFS-- <br /> Sample Type Analysis Requested 1. <br /> Number Soil Water Time TRH-g TPH-d BTEX 0 & G 8244 Metals (list) Asbestos Other Remarks <br /> 013 <br /> LO q- <br /> ` $491 i ,t <br /> Tqu . i' I — <br /> GOOD CON M0 �fi�PR �- <br /> Sampler Name (Pring 1 ,� !r~� Sampler Signature <br /> Aefin By ate and Time eCoived D/� - ate me Sampling Site Sketch <br /> Relinquished B ate grid lime Received . Date and Time + <br /> u <br /> Z <br /> Relinquished 0y Date and Time Received By. Date and Timernw�- <br /> Ralinqulshed By Date end Time Received By, Date and Tlme -m }� <br />