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� <br />c 02A SAN JOAQUIN COUNTY 0 013A <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />W0_ <br />CHAIN OF CUSTODY RECORD <br />1. sampler's Name Munlc�i0na K)6jj1 ►, Title Unit �I <br />Date <br />Time <br />item <br />Location <br />ID# <br />Unit <br />Required <br />Remarks: <br />(so ml or 1L <br />Analysis <br />Condition of Sample, <br />amber jar, <br />Temperature, etc. <br />vo,a, etc.) <br />5"-. c <br />�a <br />y�TTLC TCLP, if necessary <br />Q®tC53rLC, if necessary <br />r <br />i0 <br />S <br />m 17 MetalsPowder ❑ measuromeement vl <br />❑ 'Fine Powder' measurement <br />�A <br />(Particle size < 100 won in Clameten <br />ORm <br />saylty I <br />� ►i9 <br />HourFishgip <br />£F <br />11O <br />b//� 11 .. <br />s! <br />OTTLC fl TCLP, If necessary <br />Onecessary <br />i Jll; llp/ �""-v' <br />` <br />t r7 " c9D <br />♦� _ <br />I <br />I <br />OCam 1iF <br />am 7 Meters ❑ Chrome VI <br />O "Fine Powder- measurement <br />ii! dlameteT! <br />jl <br />Tw <br />/� � <br />V ![!� 11Ii <br />fPartitle Size < 100 IAT1 <br />Oignitabliity ❑Reactivity ❑PH0rx%�A <br />096 Hour Fish Bloassay <br />❑TTLC O TCLP, If necessary <br />OSTLC, If necessary <br />OCam 17 Metals O Chrome VI <br />O 'Fine Powder" measurement <br />iParticie size <100 ym In dlarneten <br />❑ignitabllity ❑Reactivity OPH <br />096 Hour Fish Bioassay <br />OTTLC ❑ TCLP, If necessary <br />❑STLC, If necessary <br />OCam 17 Metals ❑ Chrome VI <br />0 'Fine Powder measurement <br />(Particle size <100„'rn in diameten <br />Olgnitabliity ❑Reactrvlty OpH <br />096 Hour Fish Bioassay <br />OTTLC ❑ TCLP, If necessary <br />OSTLC, If necessary <br />OCam 17 Metals ❑ Chrome VI <br />O 'Fine Powder measurement <br />(Partlde size <100 Nrn in diameten <br />Olgnitabllity OReactivity OPH <br />096 Hour Fish Bioassay <br />3. p Evidence tape �4. ❑ sample transported in iced cooler <br />5. Relinquished by f)Mniq a Bail( Ref,> , t6'Zi 10 11. 3o any,., <br />ami Date Time <br />Received by e ,o ►>1 <br />ame Title Date Time <br />Remarks (condition/temperature <br />E. Relinquished by <br />Name 71tTe --D-ate ' ----Time <br />Receir/ed by <br />ame_P I e I Date I TIM6-- <br />Remarks (condition/temperature <br />1015/10 by kif <br />