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PUBLIC HE <br /> A1�VICE. <br /> f' r1 <br /> s,tN JonQuw cotJNTr <br /> PUBLIC HEALTH SERVI ,!��r 0 <br /> ENVIRONMENTAL „'"" t <br /> DOUG WILSON, R.E.H.S. <br /> Supervising Environmental Health Specialist <br /> Envi�((�� �'f/- CHAIN OF CUSTODY REC <br /> C�0.��i J 1 4 +/�� I Health�q nvisim P.O.Boz 2005 <br /> tal <br /> /I. SamplerJsName Tule_ 1�L n S Dept. (209)468-3446 (445 N.San Joaquin Street <br /> W 15e> /t Stockton,California 95201 <br /> Date Time item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> q101571 :Ov L 9 93 0/ �z 1 hl v b <br /> ' O 92 SotA L v P <br /> 30 q Ag?5os CJ✓ 1° <br /> 3. Evidence tape fd/ Me f= �S ¢ �c/vs,`s <br /> 4. Sample transported in iced cooler <br /> ar r <br /> o/v „o� rxcecr� T7LC . <br /> S. Relinquished by <br /> name title date <br /> time <br /> Received b (21n 16 10 e2� <br /> name title dao <br /> time <br /> remarks (conditionitemperature) <br /> 6. Relinquished by <br /> name title date time <br /> Rercived by <br /> name title <br /> date time <br /> remarks (condition/temperature) <br /> ✓) �D e✓V <br />