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i <br /> _ I <br /> SAN JOAQUIN COUNTY <br /> °-.-7, °� Please send results to: <br /> 2 ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> i Name: S'Y77/Y.f p1 VR.YLL.. <br /> y j 1868 East Hazelton Avenue,Stockton, CA 95205-6232 Email,5-r!vg'e x C d•c°m <br /> q' :;. :" Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> iFkkbFax: <br /> CHAIN OF CUSTODY RECORD <br /> // - Sample container description Required analysis <br /> RO number: JA- lq- /-7 /,Z E <br /> 0 <br /> i i o <br /> Samplers name: <br /> c y <br /> rr���� m m 2 O .� u <br /> Title: SY. GT! S _ g z . 0 <br /> v <br /> Unit: Z277 <br /> 2 a v <br /> Sample address E 5 o a w ? E <br /> ,-°, a c > z ° J w <br /> Facility name: <br /> a � <br /> i�l�f G(�- 1GCrt�r LL�ZG/, E o s � <br /> r LL E <br /> Facility address: a °-' 6 - i s <br /> (�.� / n n <br /> Facility contact: C (*ee?k 1 a� a ? o ° z y o w _ <br /> Sample Sample source Date Time i �' >v y j u i- E E LL c m x m <br /> number Sample location description sampled sampled "' t- 2 k 1- z �^ u u _ _ c" a o, <br /> MP(A�C�Y1hdPX Me A I(v15 3 ✓I C� Ib �j X x X <br /> Name pp�� Title Date <br /> �+ Date - Time Remarks <br /> Relinquished by: ` 1ta �l VV- -�[_T�`J /� �7//.5;7 �Q l'✓h <br /> Received by 5� /„ti{/ S(�{f7e/� rj-l7 fV If <br /> �U• �� Wh. <br /> Relinquished by: <br /> Received by: <br /> Relinquished by: <br /> Received by: <br /> Rev 01/23/15 CHAIN OF CUSTODY <br />