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Laboratory Chain of Custody 2003 <br />DEL -TECH GEOTECHNICAL SUPPORT Submission # <br />10624 OLIVE AVE. / OAKDALE, CA. 95361 <br />SITE NAME:TOYS R US, 1624 ARMY COURT, STOCKTON <br />(209) 847-8757 / (209) 847-7744 FAX <br />Sheet: _1_ OF _1 <br />p <br />w <br />m <br />Date <br />Time <br />Received / iquished by: - <br />DEL -TECH GEOTECH. <br />ll <br />eceive Reliquished by: <br />m <br />0 <br />N <br />pca U)P.O. <br />_ <br />Tit <br />L <br />Client: STOCKTON SERVICE STATIO <br />Report Attention: STEVEN SHIN <br />Phone: 209 468-9850 <br />Address: <br />BOX 508 <br />Project Name: <br />TOYS R US <br />FAX: 209-468-3433 <br />City, state, zip STOCKTON, CA 95201 <br />Consultant: STOCKTON SERVICE <br />P.o- x <br />Lab Use Only <br />Sampling Info: <br />Sampled by: DEL TECH <br />Lab.: SHERWOOD LAB <br />S# <br />T <br />#C <br />-Date <br />Time <br />-!.,Sample Descrition/Location <br />.Sample Container/ Preserv. <br />C <br />_�ln <br />X <br />X <br />- <br />L' <br />- <br />X <br />X <br />X <br />X <br />g <br />OC Report Type: Level [ ] 2 [ ] 3 [ ] 4 Formal COC Required: [ ] BILLING TO: <br />-- nature <br />Print Name <br />Company <br />Date <br />Time <br />Received / iquished by: - <br />DEL -TECH GEOTECH. <br />ll <br />eceive Reliquished by: <br />(Received AQeliquished by: <br />V, T 7 .T' <br />s+ m <br />7 3 a3 <br />i7 <br />Received / Reliquished by: <br />/ C / S <br />i s e, "'R "J <br />�� GcIO d� s <br />Soy d 3 <br />0 93 5 <br />5 <br />I Received / Reliquished by: <br />I <br />NOTES: ANALYSIS REPORT TO GO TO STEVEN SHIH AT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH. ADDRESS 304 E. WEBER AVENUE, THIRD FLOOR, STOCKTON, CA 95202-2708. <br />BILLING IS TO BE SENT TO STOCKTON SERVICE STATION: P.O. BOX 508, STOCKTON, 95201 0 % I l x" 4o_DeJ — x_c, 4 <br />- i -c 3 <br />