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'oP4utn co # Please send results to: <br /> G SAN JOAQUIN COUNTY WEl ILS <br /> Name: <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> W' •� Email: kfole•Rasicehd.com& M jieH•-I� �� <br /> f 1868 East Hazelton Avenue,Stockton, CA 95205-6232Fax: �"t —i�t L J(�lRS 2 J <br /> • �4c F • '�� • Telephone:(209)468-3420 Fox: (209)468-3433 Web:www.sjgov.org/ehd <br /> 'EHD staff to call for further instructions:Garrett Backus <br /> (209)468-2986, <br /> CHAIN OF CUSTODY RECORD (209)466-3451•MichelleHenry(209)468-3453,Kasey Foley <br /> Sample container description I Required analysis <br /> TA number: � E <br /> i <br /> Sampler's name: r or <br /> 1.G1 1O z o <br /> Title: � � `^ <br /> l� .. a ° 40 Z v <br /> E Z LL O U <br /> Unit: G U d <br /> Sample addressa E ° Z E <br /> '/.U/T _y � Z o sw <br /> Facility name: m o N Z <br /> E m <br /> Facility address: n a a c o H _ t <br /> E a 4o v u LL ° m a r <br /> _ u y _ v <br /> Facility contact: ° N „ r c Q) c E 3 ' - <br /> 3 ° w <br /> 0 0 . c n = Z — E a E -0 <br /> L Z ° c mSam le Sample source Date Time n a E m L <br /> — c <br /> number Sample location r g ; G u v LL c m cc za m <br /> description sampled sampled — <br /> 1 i►�1 t Pr{5 �� to a; a:db C1 IGdL X <br /> r�S (a zG »vv G N X -� <br /> Name [� Title Date Time Remarks <br /> Relinquished by: �/(� % is f .'Is n f( $2 TTU- g fW— <br /> Received by SII-I(p f�•'/SAh� i7Ci1 IILi JI W �L1� SPy!(e. <br /> Relinquished by: / i'e /er S=I I- �(p /-'00 ( rk-c to S6 a nA <br /> Received by: n�� /t/a4a4ee 57-//-/(, ���� y`(1a I y �I 5 :ks <br /> Relinquished by: rea Kt i <br /> Received by: Al 1 P (64101% / C�CH��i(/Ae C�(�'l� <br /> Rev 07/31/15 \ _= <br /> '� AIN OF CUSTODY <br />