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mm& 0"o <br />oip; <br />y-/-D214o 13 <br />MAY 2012SaN JoAQUIN COUNTYENVIRONMENTAL HEALTH DEPARTMENT UICOU 600 East Main Street, Stockton, CA 95202ENVIR H • 209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br />CHAIN OF CUSTODY RECORD <br />1��1 ----�--E� rc <br />I. Sampler's Name Title r Unit <br />2. <br />Date <br />Time <br />Item Location <br />ID# <br />Unit <br />Required <br />Remarks <br />(50 ad or 1 L <br />jar. Von. <br />Analysis <br />Condition/Temperature <br />brass tube• etc.) <br />��Aek�IoStSTLC <br />j <br />!— <br />p <br />3t to <br />6 -Hr Fish Bio§ssaPt <br />' I1--eCe•eL 1-y <br />❑Ignitability <br />e <br />❑Reactivi <br />�(� L j <br />`` (( <br />0r �1 <br />❑TTLC ❑ TCLP <br />❑STLC, if necessary <br />(� <br />096 -Hr Fish Bioassay <br />❑Cam 17 Metals ❑pH <br />/ <br />❑Ignitability <br />�iReactivi <br />0 L TCLP <br />❑STLC, if necessary <br />C196 Fish Bioassay <br />_A n ` S a, NI <br />-Hr <br />❑Cam 17 Metals ❑pH <br />❑Ignitability ❑ <br />Reactivi <br />❑TTLC ❑TCLP <br />❑STLC, if necessary <br />096 -Hr Fish Bioassay <br />❑Cam 17 Metals ❑pH <br />❑Igaitability <br />-01teactlyltv <br />❑TTLC ❑ TCLP <br />❑STLC, If necessary <br />096 -Hr Fish Bioassay <br />❑Cam 17 Metals ❑pH <br />(3Ignitability <br />Reactivi <br />❑TTLC ❑ TCLP <br />❑STLC, if necessary <br />096 -Hr Fish Bioassay <br />❑Cam 17 Metals ❑pH <br />❑lgnttability <br />❑Reactivi <br />Evidence tape 4. ❑ Sample transported in iced cooler <br />5. Relinquished by2 J ,`�/U`iJ � `r�`'T Z V <br />Name 9 Title Date Time <br />Received by M ?� <br />C f• -;q ))n <br />Na Title Date Time <br />Remarks (condition/temperature) <br />6. Relinquished by <br />ame Title <br />Received by <br />am Title <br />Remarks (condition/temperature) <br />09-07-2007 <br />441tz, y ,, 3D <br />ate Time <br />ate Time <br />N <br />