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N"ri i v o <br /> ae~ SAN JOAQUIN COUNTY <br /> Please send results to: <br /> 9 ENVIRONMENTAL HEALTH DEPARTMENT �. <br /> Name <br /> --i 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fox:(209)468-3433 Web:www.sjgov.org/ehd Email:Telephone: Liu-F e c,✓z <br /> Fax: !Zi?-%ii'•F--.3 cf.33 <br /> CHAIN OF CUSTODY RECORD <br /> Sample container description Required analysis <br /> RO number: f� / � GJ�cZ E � <br /> o ' <br /> Samplersname: <br /> a v ( Z <br /> Title: sr. f 'f—j J <br /> z m 0 V N a <br /> Unit: <br /> LL <br /> Samole address E c ., z c O <br /> z Eo <br /> Facility name: Ju S <br /> 0 <br /> / / �y C V > ; q LL t M <br /> Facility address: '"] �'7 �itJ- / �L L, j`��i�'- ���(� L ' E u w .. c _ E o -r <br /> a E _ m y u0 u m -9 , n <br /> Facility Contact: ,Q_�[�Q�r�� o N o c n z E 0 _ c <br /> Sample Sample source Date Time $ w a - a_ m E c a = m c <br /> z <br /> number Sample location description sampled sampled "' <br /> I Mrin�c�rindlr McIn ' c y 3 I�� 1 C, <br /> .y Name c /)Twee Date Time Remarks <br /> Relinquished by: - �,l V _ ' "JY /�-/ T IS �x /. lo:L7�Q/1'7 <br /> Received by SM 1,(�j s��w - /0.Sf <br /> ala ssy,�y� <br /> Relinquished by: �/� ''"7� <br /> Received by: Mae MitalgPP ST <br /> Relinquished by: <br /> Received by: <br /> Rev 01/23/15 <br /> CHAIN OF CUSTODY <br />