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o. o SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT N 600 East Main Street, Stockton, CA 95202 J Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd � rF0 CHAIN OF CUSTODY RECORD �2i"Q U1� gr— 1. Sampler's Name �/ � _Title Unit 2. Date Time Item Location ID# Unit Required Remarks: (50 ml or 1L amber jar, Analysis - Condition of Sample, Temperature, etc. VOA, etc.) `� )� < /_r CI '/1 70 (`1 (� I %rVN�C 1' I .� 3 3 c . LIRA Stijl .SfOr-l-tarnK. /� U ST pp�, Viyi U 'f ,_ TLC ❑ TryLP' PHr STLC, if necessary 2 ❑Cam 17 Metals ,+�,,,y(t-j�j � � O n ❑'Fine Powder nkasuremen� �QY ax (Partide size <100 pm In diameter) J ❑Ignitability ❑Reactivity ^4 a r"i rv� � �j y S OTTLC O TCLP []pH []STLC, if necessary or I ❑Cam 17 Metals El 'Fine Powder' measurement (Particle size <100 pm in diameter) ❑Ignitability []Reactivity OTTLC O TCLP [1pH OSTLC, if necessary []Cam 17 Metals ❑'Fine Powder" measurement (Particle size <100 pm in diameter) ❑Ignitability ❑Reactivity OTTLC O TCLP OpH OSTLC, if necessary ❑Cam 17 Metals ❑ "Fine Powder' measurement (Particle size <100 pm in diameter) ❑Ignitability OReacbvity []TTLC [I TCLP OpH []STLC, if necessary OCam 17 Metals ❑'Fine Powder" measurement (Particle size <100 pm in diameter) ❑Ignitability []Reactivity OTTLC O TCLP OpH ❑STLC, if necessary []Cam 17 Metals ❑'Fine Powder' measurement (Partide size <100 Pm in diameter) ❑Ignitability ❑Reactivity 3. F j Evidence tape r ,, 4. 2yl.Sample transported inL iced cooler 5. Relinquished by ::re//��' ey V�' Sr f��l� `�2 ' `"61 IVam itle Date Time Received by ✓ 19' S-4 ) 0 • Z ame Title Date Time Remarks (condition/temperature) 6. Relinquished by Name Title Received by , Name 05/26/10 by klf Title Date Time Date Time b rF