Laserfiche WebLink
sos"�u iN Co � *CLk I,�Z-7 Please send results to: <br /> G SAN JOAQUIN COUNTY <br /> r '� Name: <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .<I Email: kfoley@sicehd.com& <br /> '.. ,'•j 1868 East Hazelton Avenue, Stockton, CA 95205-6232 3y 3 <br /> Faz:. . •NSP Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ��oR •EHD staff to call for further instructions:Garrett Backus <br /> 1468-348i:Michelle Henry(209)468-3453 ,Kasey Foley <br /> CHAIN OF CUSTODY RECORD �209 <br /> G Sample container description Required analysis <br /> TA number: 1 l� � I E <br /> ie i �av1 z,o _ <br /> Samplers name: a o <br /> V Q . <br /> D Z <br /> Title: t7 a z m 0 °1 <br /> 111 Unit: U y > Q U <br /> o1 F- <br /> Sample address n E o z v <br /> Z J _ E <br /> 0 a c _ O Q <br /> C Q O U = <br /> Facility name: 5 _ (�,�� /, m A }O N <br /> Facilityaddress: Ea ° <br /> N a o. <br /> E 0 <br /> °1. <br /> y C <br /> Facility contact: ° v tfc tD c > 3 " ? <br /> E a - <br /> > 5 <br /> so ° — v °Na w Z E n E <br /> Sample Sample source Date Time t (U a v v o Z c' E o c u° _ <br /> number Sample location description sampled sampled ~ ~ ~ rr U " LL 'E z n o <br /> A X <br /> 12MAIJ 1A 6,1,t,4 IS.ib * C boL C oZ <br /> Name Title �j Date I Time URemarks t y���,/-1 /''- <br /> Relinquished by: ( ✓ ( 1 `kK� 1J �1{•�'j��tU��� 71 ofr rr�� �1 t iUl`60 1210o5s �/ <br /> Received by /'G >� 5-I�')�J I�l� __ 1'^ �if J <br /> Relinquished by: / /f) )'1_)� ,'r -�,1i6G 4 <br /> Received by: f r _ G�f�7C� (<Lr1L•z exe S W-/& j[� <br /> Relinquished by: <br /> Received by: <br /> Rev 07/31/15 <br /> CHAIN OF CUSTODY <br />