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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202 .c Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd CHAIN OF CUSTODY RECORD 1. Sampler's Name l 6% 1'1 Title f Unit Date Time Item Location ID# Unit Required Remarks: (50 ml or 1 L Analysis Condition of Sample, amberjar, Temperature, etc. VOA, etc.) } JZITTLC PTCLP ,099 '(140 Uk TLC, if necessary Tame 17 Metals ❑ Chrome VI , FF-�(>�.il., ( 6 lat ine Powder" measurement C4trdhi C (Particle size <190 Nm in diameter) ❑Ignitability EIReactivity '7 W�tpEITTLC (.DO 0-11L TCLP �1pH STLC, if necessary El Cam 17 Metals ❑ Chrome VI 1144 tt�� 1 t r5 j 1 w if ❑ "Fine Powder" measurement Ir;G (Particle size <100 Nm in diameter) ❑Ignitability ;DAeactivity Vkl /_3 IfTTLC OSTLC, if necessary LP [I pH � f;•,�,�� /Cam 17 Metals ❑ Chrome VI ❑ "Fine Powder" measurement I,. <K (� (Particle size <100 Nm in diameter) ❑Ignitability []Reactivity TTLCTCLP ❑pH ETSTLC, if nec ssary QCam 17 Metals ❑ Chrome VI ❑ "Fine Powder' measurement (Particle size <100 Nm in diameter) c `Cd VV ❑Ignitability ❑Reactivity 1^t r> P ?�� Y'j,(4ry dj_ t' �%) 7 1 v ii LC ETTCLP PpH STLC, if necessary Cam 17 Metals ❑ Chrome VI "Fine qo(Particle ❑ Powder" measurement I size <100 Nm in diameter) ❑Ignitability ❑Reactivity ❑TTLC. ElTCLP ❑pH F-1 ❑STLC, if necessary ❑Cam 17 Metals ❑ Chrome VI ❑ "Fine Powder" measurement (Particle size <100 Nm in diameter) ❑Ignitability ❑Reactivity 3. ❑ Evidence tape 4. ❑ Sample transported in iced cooler r 5. Relinquished b"" Ill / �`; J� �1 W `-�-- (� Ia Titl f to Time Received by 6 t1A1 �eA U Z7 Z / _ N dm Title ate Time 6. Relinquished by Name Remarks (condition/temperature) Received by , Name 06/24/10 by klf Title Date Title Date Remarks (condition/temperature) fiir Time a M.