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u co SAN JOAQUIN COUNTY 7 �?Alq6o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202 <br /> P• Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name IOU Title � � Unit[L'L <br /> 2. <br /> Date Time Item Location IDs# —knit Required Remarks: <br /> (50 ml or 1 L Analysis Condition of Sample, <br /> tuber ,jar, Temperature, etc. <br /> VOA,etc.) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> -v L2 (Particle size<100 Nm In diameter) L)i �QC; <br /> Olgnitability ❑ReactlVltyF <br /> 096 Hour Fish Bioassay Lt <br /> OTTLC O TCLP,if necessary <br /> OSTLC,if necessary <br /> OCam 17 Metals 0 Chrome VI <br /> 0"Fine Powder"measurement <br /> 'Particle size<100,um in diameter) <br /> Olgnitability ❑Reactivity❑pH <br /> 096 Hour Fish Bioassay <br /> OTTLC 0 TCLP,if necessary <br /> ❑STLC,if necessary <br /> OCam 17 Metals O Chrome VI <br /> O'Fine Powder"measurement <br /> (Particle size<100 Nm in diameter) <br /> Olgnitability OReactivity OpH <br /> 096 Hour Fish Bioassay <br /> OTTLC O TCLP,if necessary <br /> OSTLC,if necessary <br /> OCam 17 Metals 0 Chrome VI <br /> O"Fine Powder"measurement <br /> (Particle size<100 Nm in diameter) <br /> Olgnitability ❑Reactivity❑pH <br /> 096 Hour Fish Bioassay <br /> 3. Evidence tape 41 Sample transported in iced cooler <br /> 5. Relinquished by J� �' , S, t' Tl �y <br /> Names T e Dae Time <br /> Received by ��' �� � S% �F f' C <br /> ame Title c Date Time <br /> Remarks (condition/temperature) <br /> n L'o, <br /> 6. Relinquished bV-�.j u',�.1 , ,S1 <br /> Na a Title Date --Ti Ime <br /> Received bV /A 5C,0 10/'-7�/ 3 hU <br /> Name TiDae Time <br /> Remarks (con I Ion empera ure) <br /> 10/5/10 by klf <br />