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c <br /> SAN JOAQUIN COUNTY <br /> H ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202 ' / <br /> • oq sp. Telephone:(209)468-3420 Far:(209)468-3433 Web:�.sjgov.org/ehd W d K C p�j <br /> 0 <br /> CHAIN OF CUSTODY RECORD <br /> Pic (I �z) <br /> 1. Sampler's Name ��A" Title �C—EK Unit <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks: <br /> (50n rlL Analysis Condition of Sample, <br /> amber jar, Temperature, etc. <br /> VOA,etc.) <br /> 301315• s �) c )(TCLP,if necessary <br /> l 3� P TLC,If necessary <br /> t 0 60 am 17 Metals 0 Chrome VI <br /> (/4((D m* { 77;0 F ` Fine Powder <br /> —Q <br /> �Igvrtleiz< 666in lmen <br /> Elm nitabllltV ❑Reactivity OPH <br /> AA "tw) 6 <br /> Hour Fish Bwassay <br /> 30131 S l OTTLc O TCLP,If necessary <br /> S�r Ll OSTLC,if necessary p r n L <br /> II lUDo SaMd (33 IOram 17 Metals O chrome J I <br /> f l u ❑ Fine Powder measurement <br /> t <br /> (O (3l{td u 'v 0Y✓tI Olgnitabllity, ORea<100 cm in n <br /> tIVIN❑PH <br /> s �JNA� �v/11 16 096 Hour Fish Bioassay Ck Gt� <br /> OTTLC 0 TCLP,If necessary <br /> OSTLC,If necessary <br /> ❑Cam 17 Metals O Chrome VI <br /> ❑'Fine Powder'measurement <br /> (Panl°e site<100 on In diameten <br /> Gignitablllty ❑Reactivity op <br /> 096 Hour Fish Bioassay <br /> OTTLC O TCLP,If neceSsary <br /> OSTLC,If necessary <br /> ❑Cam 17 Metals O Chrome VI <br /> O'Flne Powder measurement <br /> 'Panicle site<100 Pm In°lameten <br /> Olgnitabllity ❑Reactivity ppH <br /> 096 Hour Fish Bioassay <br /> OTTLC 0 TCLP,If necessary <br /> OSTLC,If necessary <br /> OCam 17 Metals O Chrome VI <br /> O'Fine Powder'measurement <br /> (Particle size<100 vm in dlameten <br /> Olgnitabillty OReactivity OpH <br /> 096 Hour Fish Bioassay <br /> 3. �vidence tape 4. ❑ Sample transported in iced cooler <br /> 5. Relinquished by UD <br /> Tlhfem <br /> � I <br /> Received by m I –� tl I et �,Time 1 <br /> ��� �I mars onrss��I�Ion empe a ure <br /> 6. Relinquished by urlA-U � "/i'li�, I6ry� <br /> Name Title a e Time <br /> ^ <br /> Received by "J'ALt,Y (k�S tl, SJo 3'' 3 ?-/v <br /> —Name I—T"t1ebare <br /> Remarks con I Ion empera ure <br /> 10/5/10 by klf �• I <br />