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Special CHAIN OF CUSTODY <br />wwwigibmcont <br />Laboratory Copy (1 of 3) <br /> <br />111"51,ZIROMILNTAI, '7; AoRicuninu. <br /> <br />Chci <br /> <br />I 1 inhot Nun 1111111m a 35730.02/06/2017 <br />, <br />TEST DESCRIPTION - See Reverse side for Container, Presarvative and Sampling information I <br />.i. <br />Address: San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada lkO 'V Project NameNR(V\34 \W,c, c-ir ( . .)i.- - <br />Purchase Order Number: <br />Quote Number: sr 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** < <br />g <br />g <br />< <br />Z <br />IC <br />3 o a. <br />e o Z <br />srd .0 3 o a, Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Clieniz San Joaquin County EHD Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) Coliform-Colilert-PIA 120m1(PBa)-Na2S203 General Mineral 250m1(P)-HNO3 , 16oz(P), 8oz(P) Field Test-Field pH !!pH = 15 MINUTE HOLD TIME!! Field - pH Date Field - pH Time Sampler(s) <br />Sampling <br />Compositor <br />Fee: Pickup Fee: <br />Setup Date: Time: / _I __j_ <br />Lab Number: STK 91/36 6,9 4 3-17919 <br />Samp <br />Num Location Description Date <br />Sampled <br />Time <br />Sampled <br />1 WO'1/4i) CD\\\\r \ VIII\ 0 DW _ 1 1,1,1 1 AA) Sy\T V2.31) _ <br />_ <br />_ <br />Remarks: Relinquished Date: Time: <br />Nbi-f ti cA\-k,\.\-\ V.'9'. <br />Rd- • ed ,,, 1 Datte: Time: <br />./14aan 1 -Pre • <br />elmq Date: <br />Y) ei <br />R ewe By: 13,te: Time: <br />642 blii i i-/ OC) <br />Received By: b5 / Da7: Time: •i717,1 <br />W4 if`a' et:01 17 , 4 <br />alr&.. <br />iv 'd B Date: Time: <br />IPP'A, <br />v.. <br />Corsorate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory Pffice & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Undo 3442 Empresa Drive, Suite D 9415 W. Goshen Avenue <br />Santa Paula, CA 93060 Stockton, CA 95215 Chico, CA 95926 San Luis Obispo, CA 93401 Visalia, CA 93291 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 Phone: (530) 343-5818 Phone: (805) 783-2940 Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 Fax: (530) 343-3807 Fax: (805) 783-2912 Fax: (559) 734-8435