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IN, �.• v `O`) 2, I Please send results to: <br /> �o a SAN JOQUlN COUNTY <br /> y Name: Lydia Baker <br /> / ENVIRONMENTAL HEALTH DEPARTMENT Email: mnaidu(o@sicehd.com& ibaker slcehdcom <br /> I 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd .EHDstaff tocall for further instructions:Garrett Backus <br /> 1209)468-2986,Michelle Henry(209)468-3453,Kasey Foley <br /> CHAIN OF CUSTODY RECORD (209)468-3451• <br /> Sam le container description Required analysis <br /> TA number: � q /''7 5 (a (PE <br /> r LydiaBakeV W <br /> Sampler's name: v <br /> «"— <br /> Title: EHS 0 ? <br /> W <br /> a —a z m Zv <br /> Unit: CUPA(III) v Q v ¢ <br /> v <br /> 2 W v <br /> 0 = <br /> Sample address n c o <br /> E '" z a` E <br /> Brakemasters#163 c ¢ °o t� <br /> Facility name: i,n m o > <br /> c + c v m o <br /> _ c o v w v <br /> 1210 Tracy Blvd.,Tracy,CA 95376 n d } `—' 2 E o <br /> Facility address: E N E <br /> 5; - . m m a <br /> Vince Blanchard E E a �„ u <br /> Facility contact: ° w O v C c c E > 3 > <br /> - •- <br /> 0 o c n — oa a Z <br /> Sample Sample source Date Time v a v ; J J E ° m s <br /> Sample location •v—, �g w � � � vii U u : m z =a rn <br /> number description sampled sampled <br /> — <br /> M - t,,n Solid 10-8-18 "C G &oz G N N <br /> Name Title Date Time Remarks <br /> Relinquished by: r r— �i <br /> Received by <br /> Relinquished by: ! ti� ',r IL t-►Y Z .,}M emp <br /> Received by: , <br /> Relinquished by: # <br /> Received by: <br /> Rev 07/31/15 <br /> CHAIN OF CUSTODY <br />