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Please send results to: <br /> ISO <br /> AN OA UIN COUNTYName: Lydia Baker <br /> ENVIRONMENTAL HEALTH DEPARTMENTEmail: mnaidu@sicehd.com& Ibaker(@sicehd.com <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sjgov.org/ehd *EHD staff to call forfurther instructions:Garrett Backus <br /> (209)468-2986,Michelle Henry(209)468-3453,Kasey Foley <br /> CHAIN OF CUSTODY RECORD (209)468-3451* <br /> Sample container description Required analysis <br /> TA number: L611 15 1// l0 E <br /> 0 <br /> Lydia Baker a w o2 <br /> Sampler's name: c� or v <br /> rya z O <br /> Qj <br /> Title: EHS 0 m z 1. <br /> z LL <br /> Unit: CUPA(III) _ a Y <br /> } F <br /> o Cr <br /> o <br /> Sample address o- C o z v <br /> E E <br /> Brakemasters#163 o a > 0 <br /> Facility name: o a N <br /> 1210 Tracy Blvd.,Tracy,CA 95376 0' v ' N N E o <br /> Facility address: L a 2i a c <br /> CL � ° n <br /> C1 v v v <br /> Vince Blanchard o E ° a LL v ° 3 y — <br /> Facility contact: 0 ° o z a oCU <br /> ` = Y <br /> 0 0 — c Q — "_ ti <br /> cc Ci Eo <br /> Sample Sample source Date Time a v J u z r LL = v x o <br /> number Sample location description sampled sampled ~ 1-- ~ v _ 0 O <br /> Solid 10-8-18 (' G Boz G N N <br /> .s <br /> Name Title Date Time Remarks <br /> Relinquished by: <br /> r <br /> Received by i 11�4: � ' rt'L-Iry, 1 (� l,� Z/• .Y/l ty" <br /> Relinquished by: <br /> Received by: <br /> Relinquished by: <br /> Received by: <br /> Rev 07/31/15 CHAIN OF CUSTODY <br />