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�/ _ -*-7,-,4 ( 5 7 �I s <br />SAN JOAQUIN COUNTY J� I t 112-2 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202 <br />Telephone. (209) 468-3420 Fax (209) 468-3433 Web. www..3jgov.org/ehd <br />40. CHAIN OF CUSTODY RECORD <br />1. Sampler's Name Title s-; Unit �3 <br />2. <br />Date <br />Time <br />Item <br />Location <br />ID# <br />Unit <br />Required <br />Remarks: <br />(50 ml or 11. <br />Analysis <br />Condition of Sample, <br />amber Jar, <br />•+F51L C Cu, Lr) ' <br />Temperature, etc. <br />VOA, etc.; <br />:lei -v- <br />LC U�TCLP, if necessary <br />4 R// ►�. c �1�� Cc• x. <br />bl Cyt_ <br />b Ips fi <br />S` �~ <br />TLC, If necessary <br />rlCam 17 Metals D Chrome VI <br />'Fine <br />1, <br />S/ i ( <br />/ 1 0 5' <br />�_ • <br />I <br />❑ Powder measurement <br />In laeter, <br />LL A <br />Tn�' �c• " <br />( <br />(Pardcie Size < 100vm dm <br />Olgnitability OReacVvitV OpH <br />rt`Fr ic�.,1<<K q -L <br />096 Hour Fish Bloamy <br />pTTLC 0 TaP, If necessary <br />DSTLC, if necessary <br />DCam 17 Metals O Chrome M <br />O •Fine Powder measurement <br />(Particle size <100 on In dlameten <br />Olyn(tabi(Ity OReactlVlty 00H <br />096 Hour Fish Bloassay <br />OTTLC O TCLP, If necessary <br />OSTLC, if necessary <br />OCam 17 Metals ❑ Chrome VI <br />O 'Fine Powder measurement <br />(Particle size < 100 on In dlameten <br />Olpnitablilty OReactivlty OPH <br />096 Hour Fish Bioassay <br />OTTLC O TCLP, if necessary <br />DSTLC, If necessary <br />OCam 17 Metals O Chrome vl <br />O 'Fine Powder measurement <br />(PaMcie sae <100 on In diameten <br />Dlgnitabliity OReaCMIty OPH <br />096 Hour Fish Bloassav <br />❑TTLC 0 TCLP, if necessary <br />DSTLC, If necessary <br />OCam 17 Metals O Chrome VI <br />O 'Fine Powder' measurement <br />(Partici size <100 on In diameten <br />01Wnitablllty ❑Reactivity OPH <br />096 Hour Fish BloaWy <br />3. '0 Evidence tape 4. p Sample transported in iced cooler <br />5. Relinquished by Gr'�.- 2 L- t45, S j / 1 0 Z- .n- <br />ame e a m <br />Received by - -� �� lie w <br />ame Title Date -711me <br />6. Relinquished by c)ueu'f(sl <br />ame e Date Time <br />Received b� 5 l i I l , I. <br />a a e04A'je�—; me <br />Remarks con on empera ure <br />�E ccjct C, 511 -11 i I KML,3 <br />*)� OdJCd 523111 MW <br />1015/10 by klf <br />—0) <br />