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AWL <br /> SAN JOAQUIN COUNTYr ' Na .e./p�l�'Pleasesend results to: <br /> ENVIRONMENTAL HEALTH DEPARTMENT C t UC�Iro <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd Email: eI <br /> Fav: <br /> CHAIN OF CUSTODY RECORD <br /> RO number: I <br /> /� 7�"�"f— J 'n Sample container description Required analysis <br /> \`It ! i <br /> Samplers name: V = S <br /> V <br /> f� p i o <br /> Title: <br /> Unit: J = a Q ri <br /> A & rc <br /> i a o t; o. <br /> $ample address o ,i„ z cu <br /> Facility name: III S� / - If'C I.11 �/`NC m jg 10 O 5 <br /> � � a <br /> Facility address: E o <br /> n� O tg n L a <br /> Facility contact: t V a° E E N ' ii i E > o l d c <br /> Sample Sample source Date Time w $ i t a ti k � E <br /> number Sample location description sampled sampled "' u' u <br /> S sl ro�al,� -IS-l6 11 112 m <br /> S eke -i t = <br /> Na e ( QTiy—�tle�r,� ate Time Remarks <br /> Relinquished by: 4-(6 I(I S—I 41A <br /> Received byIts- <br /> f Jyyaa��1 <br /> Relinquished by: <br /> Received by: <br /> Relinquished by: <br /> Received by: r <br /> Rev 01/23/15 ! <br /> CHAIN OF CUSTODY <br /> J <br />