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`dam SAN JOAQUIN COUNTY <br /> Q' ENVIRONMENTAL HEALTH DEPARTMENT <br /> �w. 600 East Main Street, Stockton,CA 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web.www.sjgov.org/chd , `© � <br /> CHAIN OF CUSTODY RECORD W <br /> CZ Z� <br /> 1. Samplers Name Title Unit pa� � <br /> _ <br /> 2. <br /> Date Time Item Location IDp Unit Required Remarks: <br /> (so ml or 1L Analysis Condition of Sample, <br /> amberjar, Temperature, etc. <br /> VOA,etc.) <br /> OTTLC O TCLP,If necessary <br /> OSTLC,if necessary <br /> m <br /> Ora17 Metals 0 chrome vi <br /> O"Fine Powder"measurement <br /> rparticiesize<loo Pm In aiameten <br /> Olgnitabllity OReactivlty OPH <br /> 696 Hour Fish Bioassay <br /> OTTLC O TCLP,If necessary <br /> OSTLC,If necessary <br /> OCam 17 Metals O Chrome A <br /> 0"Fine Powtler"measurement <br /> (Particle size<100 nm in alameten <br /> Olgnitabillty OReactivicv OPH <br /> 096 Hour Fish Bloassay <br /> OTTLC O TCLP,If necessary <br /> OSTLC,if necessary <br /> OCam 17 Metals O chrome vi <br /> 6"Fine Powder"measurement <br /> (Particle size<100 Pm In diameter, <br /> 6lgnitabillty OReactIvIty OPH <br /> 096 Hour Fish Bloassay <br /> 0 TLC O TCLP,if necessary <br /> OSTLC,if necessary <br /> OCam 17 Metals 0 Chrome m <br /> 6"Fine Powder measurement <br /> (Panicle size<100#m In dlameterl <br /> 6lgnitabillty OReactivlty OPH <br /> 096 Hour Fish Bioassay <br /> OTTLC O TCLP,If necessary <br /> OSTLC,if necessary <br /> OCam 17 Metals 0 Chrome M <br /> 0"Fine Powder measurement <br /> (Particle size<100 gm in dlameten <br /> Olgnitablllty OReattivlty OPH <br /> 696 Hour Fish Bloassay <br /> 3. ❑ Evidence tape a. ❑ Sample transported in iced cooler <br /> S. Relinquished by \rv1L.tLj (tA ak—t4 7 LIto 9 •n< Fh"'�- <br /> a�— ITtle �Ime <br /> Received by ( p ; G G <br /> — `fie —Titsate --mime <br /> Rem r s (condition/temperature <br /> 6. Relinquished by I 11 b-IL7 q ; 'Sarw <br /> ame I e �a� T>me <br /> Received by It /T/(o 104t S <br /> Wa—Me Title — ate— IT me <br /> Remarks (condition/temperature) <br /> 10/5/10 by klf `' <br />