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• • a�) - 7-- 0 ` <br /> Environmental Services CHAIN OF CUSTODY FORM <br /> 4185 Rialto Court <br /> Pittsburg, CA 94565 Q>�.�I en �- vS � CO S J 61L # <br /> (510) 439-1024 Site Name i j L1 LA0,j C i (l E <br /> Fax (510) 439-2566 Location. p)f\f jj L CA Date C —Z 3 ` 93 <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-g TPH-d BTEX O & G 8240 Metals (list) Other R <br /> a <br /> (oo ' <br /> V2 obe olm <br /> GOW APF <br /> IA7 <br /> Sampler Name (Print) Sampler Signature <br /> ! h. VDate and Time Received By;",-Dat <br /> ,end T1% Sampling Site Sketch TN <br /> R inqulshed 8 • Date and Time Received By Date and Time No <br /> Relinquished By Date and Time Received By Date and Time A c+ _ <br /> I <br /> Relinquished By Date and Time Received By Date and nme N <br /> � l <br />