Laserfiche WebLink
Please send results to : <br /> ?see � W9*0 <br /> SAN JOAQUIN COUNTY <br /> a' tl,..'m Name: (2C1rref+ FGdG+ Email : <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton , CA 95205 - 6232 Backus@sjgov. org <br /> Ellannti Flom d o - efYo r r o @ sj110 or <br /> mass a Telephone: ( 209 ) 468-3420 Fax: ( 209 ) 468 -3433 Web : www . s ov. or ehd . .� <br /> jg g� EHD staff to call for further instructions: <br /> Crurre •,r{- Back�c,5 - 209- (01 (0 ~ 30 <br /> CHAIN OF CUSTODY RECORD <br /> Sample container description Required analysis <br /> TA number: H I S ) (a E <br /> Sampler's E laianr�a Flare e[� U o ` o o <br /> N o <br /> name: c? = @ v a V <br /> N <br /> v <br /> � �� S ° _ Y z G a G <br /> I�1 � z N N <br /> Title : ° m 4 z `o <br /> C7 Y n. Z 5 r- v N N <br /> cvP rato <br /> U 7 m 5 z N U H lD <br /> Unit: } 2' H `�` Q N .` t Lo <br /> N N N fY1 lNp U <br /> MCI '^ m z K l0 N V7 U <br /> 4 0 LID w LID ei N <br /> Sample address n o ° z_ N z_ U v N N <br /> v <br /> E v v > z U l0 Z .4 Z U to N <br /> NCf 0 cc <br /> Ty /tcm z Scc w -� i n duStna� �i l I U C r O C 0 N N U U U N <br /> Facility name : L co ° p 0 o W 4 U U m N <br /> ` � y� I L ( O N U O R O N N N N F <br /> Facility address: ( ZO "C E t ( llrl �1 • 111 V n , v a v 1. <br /> N N CN m u m H ° �` ° aN = o <br /> r' CL CNN LL N LL N L CL <br /> 1] <br /> Facility contact: �Nl� it unlr(� , MLtn �1t� 1�.�' ooE~ <br /> o c III% cL T <br /> Lo <br /> Sample Sample location Sample source Date Time v v 1. > v � N Lo U g g M L LL M `o Lo <br /> number description sampled sampled ~ ' ~ ~ "' " �' U °—° u <br /> ClfP1 � �(�?i (ji'N-1011ndr' 0 <br /> fin <br /> lue ; snr w % tiA j?t) I I IU AMG l�' C� ,( {� V/ ✓ ✓ ✓ <br /> 2hr is <br /> La <br /> Name C Title Date Time Remarks <br /> Relinquished by: CSc/ I S ID Z uz I 19 2S 1 l <br /> Received b W2, 1 2 J <br /> Relinquished by: 1 <br /> Received by: <br /> Relinquished by: <br /> Received by: <br /> Rev 02/05/2019 CHAIN OF CUSTODY <br />