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ame Title Date Time Remarks <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.oreehd <br />CHAIN OF CUSTODY RECORD <br />Samara container description Required analysis <br />RO number: Method of sampling: Composite (C) Grab (G) Type of sarnple conlainer Glass IG) Plastic (P) 1 Metal tube (MT] VOA (V) F2 rap, if necessary Chrome VI "Fine powder measurement (Particle site 0100pm in diameter) .• <br />a <br />Samplers name: Lq01.0i rmretz <br />Title: .., r• 12-r-4-1< <br />Unit: Ir. 5 <br />— <br />— <br />Sample address — <br />Facility narne7 3 I2.- 51(Yq t 0 rt- i ?....- <br />Facility address: ....1 1 C7)) • M <br />Facility contact: jALe Ille \ _kr <br />Sample Sample location Sample source Date <br />number description sampled <br />lime <br />sampled <br />a <br />Wi_1-- i-Z- Q1 •O‘Oitin <br />Relinquished by: <br />Received by <br />Relinquished by, <br />Received by: <br />Relinquished by: <br />Received by: <br />Rev 06/05/13 <br />CHAIN OF CUSTODY <br />Please send results to: <br />Name: <br />Fax: <br />Address JR Simplot. 17151 S Mickinley. Lathrop CA 95330 <br /> Record ID COATV9SDZ <br />Date 05/03/2022 <br /> Program: ER <br />PHOTO 9: <br />Chain of custody. <br />Gabriela Garcia-Mejia, ENS Page 9 of 9