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Pqu I\ # Please send results to: <br /> �o.• co, SAN JOAQUIN COUNTY 6,E112_�i <br /> G <br /> y Z\I <br /> Nam <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Email: 'r.'elev('stcehd.com& /YIhP✓t J <br /> L � � <br /> `� 1868 East Hazelton Avenue,Stockton, CA 95205-6232 N 3 3. � <br /> Fax: 3 <br /> Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> 'EHD staff to call for further instructions:Garrett Backus <br /> 209) <br /> CHAIN OF CUSTODY RECORD (209)469.34468-2986,1- <br /> Michelle Henry(209)468-3453,Kasey Foley <br /> Sample container description I Required analysis <br /> TA number: E <br /> i <br /> 0 <br /> a 3 <br /> Sampler's name: kin, <br /> o� <br /> ~ o • <br /> Title: N <br /> Z <br /> Unit: U <br /> v v ¢ d <br /> O V ? Y = N C <br /> Sample address a `- o z v <br /> _ E z a (_ — E <br /> (— C A a szO b 11 = v= <br /> Facility name: �/VW T 7 m o <br /> // N <br /> a o ° i Z LL Z E <br /> Facility address: E a a c O Q '„ _ .0 <br /> Facility contact: ° v C Q� c 0 c E > 3 w <br /> Sample Sample source Date Time v a v a Z E o c c 9 L <br /> number Sample location description sampled sampled ~ cc v v c m n <br /> 1 rl� i p�{5 S lD �b a d6 G IGdL ( I AIX <br /> r� I o �'. G ►6f� G N XKN <br /> Name L Title Date Time 1� Remarks <br /> Relinquished by: �/(� % 1' r� '�SG�1^ `�'Y # $2 -(-' u, -f "i'!i D Lill <br /> Received by If <br /> Relinquished by: /6 ler ce�6 Q Yl� 1 rl V l0 ll/t/ <br /> Received by. L7�� paf7aLJee ��—�� /3op �i 11G I y S� s -{�S�"► <br /> Relinquished by: rna�A Ill yea Ott S4rd <br /> Received by: (oe UT W/ C4jj1j ll�14.0 M(/r tj <br /> Rev 07/31/15 ! l <br /> r 2M)L4 a y S--q) , CHAIN CFC'USTODY <br />