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qu)N FI ) <br /> `y D Please send results to: <br /> co SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL Name: <br /> <� <br /> ENVHEALTH DEPARTMENT ai <br /> I Email: mnaidu�tcehd.com& zbackuswsicehd com -�1� ` '�- I L' <br /> •; 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: 209 468-3420 Fax: 209 468-3433 Web:www.s ov.or ehd <br /> qti�pRN P � ) � ) Jg �� "EHp staff to call for further instructions:Garrett Backus <br /> (209)468-2986,Michelle Henry(209)468-3453,Kasey Foley <br /> CHAIN OF CUSTODY RECORD (209)468-3451• <br /> ��p-{ Sample container description Required analysis <br /> TA number: ' <br /> '1 ' Z Z £ <br /> Sampler's //yu N ° ° e <br /> name: v <br /> p CJ H u N ry I N N <br /> Title: �C� V l_ I t7 12 : -2 p iR 3 1O N ^ N O <br /> Z on CO = -.x NI <br /> d N <br /> Unit: <br /> ko a-i d ri N U •J <br /> y Z Y a t0 C tp � N (1 <br /> Sample addressp p _z N z u n a, r U <br /> N �L <br /> Yr�]�/� }� V C Q } O C � N N cc w V j V N <br /> Facility name: �' V �/i� 1l/V' V 1f ao g O o O w n v u D u U Q <br /> c p _ <br /> �i (I' / j� 1 a $ " > > u w u N £ N N ~ m <br /> Facility address: _ � 1� ° 1 ` I� DQ £ v v v c N N m u m .°—_: t a °' = a <br /> u�l O. O• Q U N N Q N Q ate+ i- N H 2 <br /> / �ffr�� ,� I I J £ £ Y N a v~ F� <br /> Facility contact: l/` K,LO iI`1 S p�� o o H v t' _ o _ o £ > 3 w , ` <br /> Sample Sample source Date Time w v CL a, T2 a < a £ 2 1 c • •� " ` L <br /> Sample location g -, r' „>, r N ; U LL no u 7. <br /> number description sampled sampled <br /> CA I`A r �� �I�ti��� �x � G-' -vl <br /> 1t-y"cjitwei P (AtA r fi on <br /> *1 0-VA * crani lt; I► i�j 4l) CT j�. y 'C x X _pZ <br /> A105u-b 4$t pr6in 13ui <br /> lir F VVY-ber) (1 l 3� `�� ►� C7 j�;. y <br /> I <br /> Name Title Date II Time Remarks <br /> Relinquished by: I `�) `l `,Ot.I DO <br /> Received b 1LP f La rD 10 Ary, - LASER #1 <br /> Relinquished b • a I 1 I:130 AM <br /> Received by.. Ojq�ez -N I(.f-/zztyw i i y i r //00 <br /> Relinquished by: <br /> Received by: <br /> Rev 02/05/2019 CHAIN OF CUSTODY <br />