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SAN JOAQUIN COUNTY Please send results to: <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> ur <I Name: UMa <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 d . �� <br /> Telephone: 209 468-3420 Fax: 209 468-3433 Web:www.s ov.or ehd Email: C <br /> < Foa P ( 1B �1 <br /> Fax: <br /> CHAIN OF CUSTODY RECORD <br /> RO number. JASample container description Required analysis <br /> n`�{1n�('�1���� E <br /> Sampler's name: Ug a v <br /> Title: � 'n � ° <br /> Unit: <br /> « w a <br /> Sample address c, E " o we <br /> ���ivc a 5z oo <br /> Facilityname: %ffA"- a* `'o> — av <br /> N <br /> A T EFaciliN address: oQ <br /> —1 � <br /> Facility contact: �� l f'1 J/Q.{��.� ° m <br /> Sample Sample location Sample source Date Time H F > F k N u u a m n m <br /> number description sampled sampled — <br /> t�let�- SK &AAd haw -26•I 46 6 G W I Y X x X X X <br /> Name Title Date Time Remarks <br /> Relinquished by: Uenah �✓r, l <br /> Received by — 11_14Iff 3.1EZ <br /> Relinquished by: <br /> Received by: <br /> Relinquished by: <br /> Received by: <br /> Rev 06/05/13 <br /> CHAIN OF CUSTODY <br />