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SAN JOAQUIN COUNTY Please send results to: <br /> �0 Nti :K <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 1868 East Hazelton Avenue,Stockton, CA 95205-6232 Name: <br /> qP Telephone:(209) 468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd Email: <br /> �1FOR <br /> Fax: <br /> CHAIN OF CUSTODY RECORD <br /> —•-�� / I Sample container description Required analysis <br /> RO number: I E <br /> i <br /> 0 <br /> Sampler's name: A��('a� .(1 -� �. ?; o <br /> Title: iO V <br /> U Y 6 Z W <br /> C V <br /> Unit: r Y <br /> v °1 <br /> N <br /> w a <br /> z <br /> Sample address o u r <br /> o E <br /> 1 `v Z S a <br /> o u <br /> _` <br /> 1 N <br /> Facility name: �I YA Qkt 0 V a m <br /> , II o u <br /> Facility address: ] fl �' M w ape j' Lyt �'—)V E w °' u; N E o <br /> n i a <br /> Facility contact: AL N w r c c E > 3 w <br /> E n E m 2t; > <br /> Sample Sample source Date Time w v >v a F m r s e <br /> number Sample location description sampled sampled '" <br /> 5 Oa IonCuM2�,la 5Jq Iort L'orlic+1nu.j <br /> tnS'1 i�0 Sha \2—IJ-I S'u7ay � 7(acZ GX XX <br /> J Name Title Date Time Remarks <br /> Relinquished by: <br /> Received by <br /> Relinquished by' <br /> Received by: <br /> Relinquished by: <br /> Received by: <br /> Rev 06/05/13 CHAIN OF CUSTODY <br />