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i • i <br /> PARKER <br /> Environmental Services CHAIN OF CUSTODY FORM <br /> 4185 Rialto Court _ <br /> Pittsburg, CA 94565 <br /> (510) 439-1024 Site NaMe heu,pa <br /> Fax (510) 439-2566 Location 8 12 o-,,A S.. ra,v�,k-9-cc- Cok- , Date c' 3 <br /> Sample Type Analysis Requested <br /> Number Soil Water Time TPH-g TPH-d BTEX 0 & G 8240 Metals (list) Other Remarks <br /> Herz c o�,ryt t� Thr <br /> N� .21826 _ ., , <br /> -'11828 <br /> 'No, '21879 KEM .�. <br /> Sampler Name (Print) 'TIM Ke Sampler Signature t <br /> Rellnquls By: Date and Time y Received . Det and Tyne Sampling Site Sketch <br /> elinquished By: Date and Time Rece ed By Date and Time p 3 <br /> t <br /> Relinquished By. Date and Time Received By Date and Time q7hr <br /> Relinquished By Date and Time Received By Date and Time j ! <br />