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Please send results to: <br /> uly �o SAN JOAQUIN COUNTY C(.oEl1Z` 1 <br /> 2 :� <br /> ENVIRONMENTAL HEALTH DEPARTMENT Name: <br /> Email: 'rfd,rrC^?sicchdcom8 M�PV3rrrttt��� L �1� <br /> '. 1868 East Hazelton Avenue,Stockton, CA 95205-6232 �w y ���.r" ) <br /> Telephone: 209 468-3420 Fax: 209 468-3433 Web:www.s ov.or /ehd Fax: <br /> �4�IFOPdvP P � ) ( ) Jg g <br /> 'EHD staff to call for further instructions:Garrett Backus <br /> CHAIN OF CUSTODY RECORD 1209)468 3451468-2986'. <br /> Henry(209)468-3453,Kasey Foley <br /> Sample container description Required analysis <br /> TA number: -� i <br /> 0 <br /> Sampler's name: d v <br /> r [, _ <br /> s.G, F�C/'y�S Z N <br /> l I <br /> Title: �" <br /> d ° m Z u <br /> I1 Z <br /> Unit: U' a <br /> � G � a <br /> v o 0 <br /> O � � z <br /> Sample address <br /> E v w > z ° _ J s E <br /> LW T�— a _ <br /> Facility name: m O <br /> o i t LL Z E <br /> Facility address: E ° <br /> N d u v <br /> Facility contact: m° _ w p c Z c E v o v �' <br /> t ° ° v a Z E ' r <br /> Sample Sample source Date Time a ° a s -0 a Z E ° c E <br /> number Sample location description sampled sampled ~ cr u _c m a <br /> 1 r�1 Ti PrrS S" �o �� a )bp, 0 1641-1C _by <br /> 06a �'. ►6vv G N X —cL <br /> Name ( , Tiittle Date Time Remarks <br /> Relinquished by: W\ !/ v Ci 8 <br /> 0'Y"K # 14,2— -TT t, fio—, <br /> Received by SII— (y �� JSacy r 1 i c7li►I�(i �T) /(� <br /> Relinquished by: 7 7�B/ ��J �gl� �- I� y0 i� vK ccx art <br /> Received by: L jfl /"(Q/1 R9f'� S��-1(0 <br /> Relinquished by: r� r wt /-k <br /> Received by: iYl l �(/+ I L(�JC (Z 6Z�Itjw mUrt� <br /> Rev 07/31/15 r <br /> l '� L{ CHAIN OF CUSTODY <br /> _ I,LA c,-* <br />