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PARKER CHAIN OF CUSTODYFORM <br /> Environmental Services <br /> 190 East 7th Street p <br /> Pittsburg, CA 94565 Job, Clipol. 1/3-24—OdYl TTh 64s+o V 7z PG �U <br /> (925) 439-1024 Site Name o rw, n fore 3 <br /> Fax (925) 439-2566 LocationDr- r . a„� - � ;•�e a� c Date <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-g TPH-d BTEX O & G MTBE Metals (list) Asbestos Other Remarks <br /> �o:�s �C � S 30255 <br /> x 30256 <br /> !AW-3 11=Y0 �C � 30257 <br /> 41h-� 1=35- K 30258 <br /> Mw-5 x 30259 <br /> A&62-C, XC 1=0 'C 30260 <br /> 1�:357 30261 <br /> f4 10-3701 >C 30262 <br /> Sampler Name (Print) Robe t er Sampler Signature <br /> Relinquished By Date and Time Received By Date and Time Sampling Site Sketch <br /> �-;'DO )1.0S e VoO&G NIFALS(CTHER <br /> Relinquls ed By Date and Time Received By Date and Time {{ <br /> PR£SERVATI�?l� <br /> Relinquished By Date and Time Received By Date and Time GOODCONDITION APPROPRIATE <br /> If AD SPACE ABS E���_,.�,ZCON�'TAINCRS ✓ <br /> Relinquished By Date and Time Received By, Date and Time <br />