Laserfiche WebLink
CDFW I �ngoE) <br /> (Rev. 05.2013) LABORATORY CHAIN-OF-CUSTODY FORM <br /> California Department of Fish&Wildlife <br /> 2109 Arch Airport ltd.,Suite 100 <br /> Stockton,CA 95206 <br /> Phone: (209) 234-3420 Fax: (209)234-3455 <br /> SUBMITTER: <br /> (please complete Sections 1 &2 and relinquish in Section 3.) <br /> Document all evidence transfers in Section 3 (page <br /> 2 <br /> SECTION 1 <br /> Investigator Name: Kathy Hieb Date Submitted: 02/11/2016 <br /> Agency: Agency Case No.: Wastewater <br /> California Department of Fish and Wildlife <br /> Address: <br /> 2109 Arch-Airport Rd. Suite 100 <br /> City/County: State: ZIP Code: <br /> Stockton CA 95206 <br /> Phone No.: (209) 640-4642 Fax No.: (209) 234-3455 E-mail: Kathy.Hieb@wildlife.ca.gov <br /> Emergency Contact: Kathy Hieb Phone No.: (209) 2343484 <br /> Submitter: Agency: CDFW Date: <br /> Telephone: 209-234-3426 02/11/2016 <br /> Print Name): Michelle Avila <br /> SECTION 2 <br /> Submitter Description: Include the number of containers, identification number(s) and a physical description of each sample if <br /> any submitted for testin Relinquish sample(s) on page 2. <br /> 1—1 gallon sample of solid wet waste[Composite#1] collected at 8:30am on 02/11/2016 <br /> 2- 1 gallon sample of solid wet waste[Composite #2]collected at 8:30am on 02/11/2016 <br /> Analysis to be performed: Polisini and Miller 1988 Static and Acute Bioassay Procedures for Hazardous <br /> Waste Samples <br /> Results requested by: C. O. B. 02/26/2016 <br /> Lockbox Evidence Seal Number: <br /> NOTE: DOCUMENT TRANSFER OF SAMPLES/EVIDENCE ON PAGE 2 (SECTION 3) <br /> 1 of 2 <br /> Page 7 of 9 <br />