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11/24/2010 WED 13: 27 FAX 2094633 SJC EHD • 2007/006 <br /> -� COPY <br /> SAN JoAQuin' COUNTY <br /> r' ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. <br /> 600 East Main Street, Stockton,CA 95202 <br /> - �P Telephone:(209)468-3420 Fav(209)4663433 Web:www..sjgov.org/eiid W/o - <br /> 4% CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name� A" Title r2� Unit <br /> 2. <br /> Date- Time Item Location ID1 Unit Required Remarks: <br /> (so ml or 1L Analysis Condition of Sample, <br /> amber Jar, Temperature,etc. <br /> VOA,etc.) <br /> 301315• Seal LC pecess if necessary pyy / Sq r of <br /> TLC,If necessary 0 <br /> 10.00 I*P(32, ! ! am 17 Meter O Chrome VI <br /> -_�l!. O�r Fme Powder'measurement <br /> 11/4110 GNr •Si �"'f ` 0loapartive nitebllhyr OReactIVin in INOPHn -D <br /> 'INAIW /} 096 Hour FIS6 Bioassay <br /> 30131 S OTTLC O TCLP,If necessary <br /> rsOtLf OSTLC,If necessary <br /> �OCam17Metals Ochromevi <br /> I IOQO4-0 <br /> II !O Q HnF3� � OaieseerawamaetSMt S-Poon wlPizLmnmen • I� 11 <br /> 019nitablRN OReacthilry OPH (^nt�1Wd <br /> WNrtH nslvAi ' t3 096 Hour Fish BioaSSaP <br /> OTTLC O TCLP,If necessary <br /> OSTLC,If necessary <br /> OCaml7Metals OCnromeVl <br /> D•FPrticle size to Onndiameter) <br /> 019nitablllN DReaLTIVIN OPH <br /> I 096 Hour Fish Bloa$SaV <br /> OTTLC O TCLP,If necessary <br /> OSTLC,If necessary <br /> OCam 17 Metals O Chrome VI <br /> D'FaePowder'mmaetFIzlooUm In <br /> 096 intablHourlFish 8103SSaVN IOPH <br /> OTTLC O TCLP,If neceSSary <br /> OSTLC,If necessary <br /> OCarll 17 Metals O Chrome VI <br /> ❑'Fine Psize owder- <br /> in diameter; <br /> 019nitabillty OReactIVIN OPH <br /> 096 Hour Fish 9loassay, <br /> 3. %,Evidence tape 4. ❑ Sample transported in iced cooler <br /> S. Relinquished by ant a af" K619rf !r (0IJ 3' 06em <br /> Name, ITtTe_ Date <br /> - Time <br /> Received by <br /> m I e e —Time` <br /> mars on I lon empei a ure � <br /> 6. Relinquished by INU � //1�'l, (D 2J Tom/ r�1 <br /> ame I e 'Date � Time <br /> Received by '.jillA4 Nki <br /> Warne I Me <br /> c s con I ion empera ure <br /> 10/5/10 by kit �' <br />