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u <br /> '6A SAN JOAQUIN COUNTY I�20d <br /> _ c�` emp 2.- C LASER #1 Please send results to: <br /> H <) ENVIRONMENTAL HEALTH DEPARTMENT <br /> Name: C.• 6,Ck/,,.5 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> p•• Email �►1 ��G/L�(,ti 11 <br /> FOR;'s Telephone:(209) 468-3420 Fax: (209) 468-3433 Web:www.sjgov.org/ehd _ <br /> CHAIN OF CUSTODY RECORD <br /> Sample container description Required analysis <br /> RO number: ©, 4.5 Cc 1 S E <br /> Tip n o <br /> Sampler's name: - -�1=���� Ctr�`^rl �? o <br /> � <br /> G--rX r- [_(� - <br /> Title: - <br /> o z u <br /> m v <br /> C V <br /> Unit: a t <br /> O u Z } <br /> Sample address cL o = v <br /> o V v > z <br /> U C O J a <br /> Facilit name: t ,�. <br /> e-C /_ Q o > r u ' E L <br /> Facility address: ,Q.�-� �j +OG 1� �., a, a � v N 6 z°- <br /> :° <br /> o Ea u u a ao w <br /> Facility contact: ° m a E > <br /> .O in ,0. u O <br /> O O _ C O_ O. > > w <br /> O Ri <br /> L <br /> Sample Sample source Date Time v v a c u E ti _ <br /> number Sample location description sampledsampled ~ F u u " m n rn <br /> /o�z-5 /4 <br /> X16 Y <br /> —01 <br /> e. 12– <br /> Nam e <br /> r 2Name )) Title Date Time Remarks /O5 S <br /> Relinquished by: r &icG�ns L �7>^ C �'j7;(�� ��' r.1 9% <br /> T.. <br /> Received by _$(/�/ �nt�t� rrr 7 5 l�f lei 10 `I7 e1 /05S S. .Sty k4,),l 4,5 <br /> Relinquished by: �SCtT �tr/A1GG 1�E -S J pYVi re I�ny V;s6c� at ?j/p <br /> rr /� �6E��,0/ ) �i 7 e��1OYI <br /> Received by: ;C Z11 ;r /Z" C !� ! 7 ) t-�r-�Ve J� w -4 6 L— /-7_,X �nP <br /> v <br /> ell <br /> Relinquished by: S,—� ZO C <br /> Received by: ,� /C , <br /> ? S'vG utn <br /> Rev 01/23/15 <br /> CHAIN OF CUSTODY <br />