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�a Fd-7 l4 -t-A [c(�14 3c <br /> 'W>r'Alk ,Ys„tlk—, i-D �a�tf�'i�, <br /> �o. coG SAN dOAQUIN COUNTY �FL��� L J•,���,1d•�;1 <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> J <br /> 600 East Main Street, Stockton, CA 95202 T�lu4T-aa <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name t I;j(T_✓ 11A Title Unit �> <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks. <br /> (50 ml or 1L Analysis Condition of Sample, <br /> amberjar, Temperature,etc. <br /> VOA,etc.) <br /> LC [] CLP .UpH <br /> TLC,if necessary �► <br /> I L,t�� am 17 Metals ❑Chrome VI `Ct(f: �{ L��' <br /> ,jl "Fine Powder"measurement <br /> (Particle size_<19D ym in diameter) <br /> ❑Ignitability ZlReactivity <br /> TTLC aTCLP J�I{iH Gln <br /> l l�, STLC,if necessary <br /> t c..' <br /> ElCam 17 Metals ❑Chrome VI <br /> ,!N •`� t t rYY l O"Fine Powder"measurement <br /> l (Particle size<100 pm in diameter) <br /> l KIr L ❑Ignitability ,BAeactivity <br /> I[JTTLC ;aTCLP ❑pH <br /> (i'• t�. �� LJ �� I STLC,if necessary <br /> a�i 1 OCam 17 Metals ❑Chrome VI 3 <br /> N(( 1 r'l ❑"Fine Powder"measurement <br /> (Particle size<700 pm in diameter) <br /> ❑Ignitability []Reactivity <br /> TTLC P TCLP ❑pH <br /> 'ZICl ' � /Z STLC,if ne ssary <br /> PZr7''] �;i l )3Cam 17 Metals ❑Chrome VI <br /> (y1 ❑"Fine Particles eeize t 00 measurement <br /> nrdiameter) <br /> ❑Ignitability ❑Reactivity <br /> 2n7LC ,p'TCLP j2pH <br /> STLC,if necessary <br /> ;t c �� L Cam 17 Metals ❑Chrome VI vG, <br /> r'� <br /> ztG�� ❑"Fine Powder"measurement <br /> (Particle size<100 Nm in diameter) <br /> M- 10 ❑ignitability ❑Reactivity <br /> L V6 L CL; ❑TTLC ❑TCLP ❑pH <br /> ❑STLC,if necessary <br /> ❑Cam 17 Metals ❑Chrome VI <br /> ❑'Fine Powder"measurement <br /> (Particle size 000 Nm in diameter) <br /> ❑Ignitability []Reactivity <br /> 3. ❑ Evidence tape 4. ❑ Sample transported in iced cooler <br /> 5. Relinquished b� I ' , Ir � ' ell , 121 <br /> ,a Titl to Time' ! <br /> Received by(. �� !la L �' ^ Z 7 ) 2- <br /> NI(mce Title bate Time <br /> Remarks (condition/tempe a re) <br /> 6. Relinquished byL <br /> N Title 15ate Time <br /> Received by Lo.Z1 - 2TS a <br /> NalTitle Date Time <br /> lt�foLv�� Remarks (condition/temperature) <br /> �'l r 9�0 <br /> 06/24/10 by klf <br />