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PARKER <br /> E CHAIN Environmental Services N OF CUSTODY FORM <br /> 4185 Rialto Court <br /> Pittsburg, CA 94565 <br /> rO 439-1024 *,,„ e,- <br /> Fax (M 439-2566 Location: 1n Date <br /> I <br /> Sample Type Analysis Requested <br /> dd Number Soil Water Time TPH BTEX Oil& Grease 9240 Metals (list) Other Remarks <br /> D`1 X <br /> i(: <br /> 3q TF 14 f�S <br /> I'Vo{ <br /> r <br /> - <br /> g- -Z`� k 133 01 y X <br /> Sampler Name (Print) Sampler Signature — <br /> elinquished By Date and Time ReceiyO By Date and Time Sampling Site Sketch <br /> Q-6�( t <br /> q 3: <br /> Iinqu ed y Date and Time Received By Dale an e <br /> Relinquished By to and Time 'Received By Date and Time <br /> fished By Date and Time IR eived By, Date agd_Time <br /> I L,7 r-- <br />