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SAN JOAQUIN COUNTY '&�I I I nv Please send results to: <br /> - � I � fvva <br /> IN. K <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 Name: <br /> Telephone:(209)468-3420 Fox:(209)468-3433 Web:www.sigov.org/ehd Email: <br /> Fax: <br /> CHAIN OF CUSTODY RECORD <br /> rSample container description Required analysis <br /> RO number. Li <br /> -'� I I \�^ ( E <br /> Q��'{'(1 _ <br /> Sampler's name: � Ca` , -Q -�} g <br /> Title: <br /> c � 3 <br /> Unit: ' L <br /> d d <br /> C H <br /> � m a <br /> Sample address E = o w E <br /> 1 _ a `w <br /> Facility name: ►J i \ ' IJ�yA�(p kp(h m t: a A ' <br /> MO <br /> 7aQ r' MC�Y1lfl��Y' L'n D'I� n m `! i t Z, — E <br /> Facilityaddress: m a. o. <br /> n <br /> r <br /> Facility contact: �°p n " u c c e E c d L .'r <br /> t a _ c n = = ,^K E n E n Z <br /> Sample Sample source Date Time w n d ,��, E e = o n r <br /> number Sample location description sampled sampled '^ r "' It: k � a ti !` c m n m <br /> S 0� io nCJMe.n 5 c.Imp Gn+H�v���-1.0-I <br /> ,nsu(p ShJ 3.0-7M Gn !(edz (1\ L N x X <br /> Name Title Date Time Remarks <br /> Relinquished by: j- s q C. <br /> Received by <br /> Relinquished by' �tt}t ej !7-,J�j,/t,� f Gi_... <br /> Received by: <br /> Relinquished by: 876- /1-16 le.( J j'30 <br /> Received by: <br /> Rev 06/05/13 <br /> CHAIN OF CUSTODY <br />