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t\C( 1 A1\-V <br />SAN JOAQUIN COUNTY • 011 9 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />CHAIN OF CUSTODY RECORD <br />1. Sampler's Name \ith At.( t\1 Title Le At) • (Z6-1 <br /> <br />Unit 3 <br /> <br />Date Time Item Location ID# Unit <br />(50 ml or 1L <br />amber jar, <br />VOA, etc.) <br />Required <br />Analysis <br />Remarks: <br />Condition of Sample, <br />Temperature, etc. <br />gsb3 <br />v j .P#41- <br />1 Lk, co.e. <br />soto <br />p ‘ LE. <br />ii_. <br />5 0 AA L <br />1TTLC <br />STLC, if neceNrss <br />aiTCLP OpH <br />Cam 17 Metals Chrome VI , if,.. <br />0 "Fine Powder" measurement .-- <br />Ol <br />(Particle size <100 pm in diameter) <br />gnitability OReactivitk ats‘ 16,4h6 <br />Con, v..) t tit, <br />A's 1+ 1 c o 1 i 6 61 28111 1131 A 1 <br />II:Ligt 1 <br />(ort.) <br />P 1 G <br />2,- <br />g1T <br />el <br />LC NiTCLP 0 pH <br />STLC, if necessary <br />Cam 17 Metals N Chrome VI 14 <br />"Fine Powder" measurement I <br />(Particle size <100 pm in diameter) <br />Olgnitability OReactivit A ,. • . d <br />PrS1A Soil -D <br />i <br />IV( 4 P TOTE <br />( <br />EiTLC tgi TCLP 0 pH <br />TLC, if necessary <br />am 17 Metals tg Chrome VI, ;C <br />0 "Fine Powder" measurement <br /> <br />(Particle size <100 pm in diameter) Ili <br />Olgnitability DReactivit(4, kr., <br />&VAC 01 cCa" <br />L; GA/ V b <br />V <br />Incr pi f), <br />V <br />EITTLC 0 TCLP 0 pH <br />ESTLC, if necessary <br />OCam 17 Metals 0 Chrome VI <br />0 "Fine Powder" measurement <br />Ol <br />(Particle size <100 pm in diameter) <br />gnitability OReactivity 4, . . —a <br />131-0141 pilpt.) <br />1/%. 1 Clijefb q <br />, ...ii SO N, li • <br />OTTLC El TCLP OpH <br />OSTLC, if necessary <br />OCam 17 Metals 0 Chrome VI <br />0 "Fine Powder" measurement <br />(Particle size <100 pm in diameter) <br />Olgnitability OReactivity <br />OTTLC 0 TCLP OpH <br />OSTLC, if necessary <br />OCam 17 Metals 0 Chrome VI <br />0 "Fine Powder" measurement <br />(Particle size <100 pm in diameter) <br />0 Ignitability 0 Reactivity <br /> <br />3. Evidence tape <br /> <br />5. Relinquished by <br />Received by <br />4. Sample transported in <br /> , (AIM V efii, 610/N , <br />m Title ate <br />ee POt , <br />Title P ate <br />iced cooler <br />3f; c <br />Time <br />6-470, <br />Time <br />Remarks (condition/temperature) <br />6. Relinquished by <br /> <br />Name Title Date <br /> <br />Time <br />Received by <br /> <br />Name Title Date <br /> <br />Time <br />Remarks (condition/temperature) <br />06/27/12 by RvFf