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i <br /> *PARKER <br /> Environmental Services CiHAI QF CUSTODYFORM�s <br /> 190 East 71h Street <br /> Pittsburg, CA 84565 <br /> (510) 439-1024 1,9iteName <br /> FaX (M) 439-2566 Location: d d Hca nA Date Ju ( V L? r <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-9 TPH-d BTEX 0& 0 a240 Metals (list) Asbestos Other Remarks <br /> Eu 3 �/ Z a ✓ 54f <br /> 5491 <br /> -� 54912 <br /> .IN --jurtulmmil <br /> GOOD CON MOUI AnIffib TE <br /> Sampler Name (Prlrttj I f'k� Afe: Sampler Signature <br /> Aelfn h By; ate�d Time eceived Date ms Sampling Site Sketch _ <br /> . _- <br /> Rellnquished B : ate and Time Received : Date and Time n tp L <br /> Relinquished By Date and Time Received By. Date and Time lv' ~� <br /> SI - `rr`w <br /> Relinquished By Bate and Time Received By: Data and-nme -m�� <br />