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• •t-��J i lr'� <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />"^ Donna K. Heron, R.E.H.S. Program Coordinators <br />< <br />Director 304 East Weber Avenue, Third Floor Carl Norgren, R.E.H.S. <br />,t <br />Lourie A. Calkins. R.E.H.S. Stockton, California 95202-2708 Mikc Huggins, R.E.ILS., R.D. <br />. �9rl FSPN`P .i.ssisat It Director Telephone: (209) 468-3420 Margaret Lagorio, R.E.H.S. <br />Rnbert McClellon, R.E.ILS. <br />Fax: (209) 464-0138 Jen' Carrucaco, R. E.H.S. <br />Website: www.sjgov.org/chd/ Kesey Foley, R.E.H.S. <br />CHAIN OF CUSTODY RECORD <br />1. Sampler's Name 01'Ji A'p Q nr Q 4 ' DU Title Unit <br />2. <br />Date <br />Time <br />Item <br />Location <br />ID# <br />Unit <br />Required <br />Remarks <br />Semlwt L <br />Analysis <br />ConditionJTemperature <br />bma W W. etc. <br />,,,1 <br />W4— �L <br />L y+r� <br />CVTCLP <br />TLC. i( necessary <br />Fisa a- <br />1 - <br />pU 11 OWS�C- <br />Ills <br />t"V <br />1 ✓I <br />`�r(6V1 <br />l� <br />I <br />m17 Metals �p <br />9 ably weiamty <br />TTLCTCLP <br />. n <br />TLCecessary <br />6Hr Fish Bbassay <br />V� <br />r <br />S f/ M� <br />6 <br />Cam 17 Metals pH <br />1 nasdA ivi <br />TTLC 0 TCLP <br />OSTLC, anecessary <br />OBB-Hr Fish Bioassay <br />OCam 17 Metals OpH <br />01 n3ablkv OReadvitV <br />`f <br />TTLC O TCLP <br />OSTLC, a necessary <br />Oso -lir Fish Bloomy <br />OCe n 77 Metals OpH <br />nllabm OReecW <br />Cl*I C 0 TCLP <br />OSTLC, Knecessary <br />090 -Hr Fish Bioassay <br />OCam 17 Metals OpH <br />I nilapT Reactive <br />OTTLC 0 TCLP <br />OSTLC, a necessary <br />096 HW Fish Bloomy <br />OCam 17 Metals OpH <br />QlqniwblWy OReadvity <br />3. F Evidence tape 4. ((Sample transported in iced cooler <br />5. Relinquished by Rk" U✓/' � ' Sr` ZI; GCS itgoY -? Y319 <br />Name Title Date Time <br />Received by T P/kL ,e�/0//6/UJ <br />Name Title Date Time <br />�i Z/l/Ef��¢,A7//O✓ <br />Remarks (condition/temperature) <br />6. Relinquished b l 9Z4C O —/0'0' 4L �4--3�%% <br />Name Title Date Time <br />Received by alao( , I tohLq ILg3 ,tiM <br />Name Title Date Time <br />Remarks <br />