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Appendix H I '1' -06 <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CMN OF CUSTODY RECORD <br /> 1. Samolers Name ,Vv IISOVI Title S (VlSD r Dept SSG. EYI V I�D✓l <br /> Date Time Item Location ID* Unit Required Remarks <br /> Analysis ConditionlPemperature <br /> I <br /> I' I11M 12•.15P <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> I <br /> I <br /> 3. Evidence tape ) <br /> 4. sample tzansportnend..,,in,,iced cooler <br /> S. Relinquished byW� `*U^qFA+S Z-710D <br /> name title date time <br /> Received b). -t— 0_ A i.— G oo t2 <br /> name title 1 �� date time <br /> remarks (conditionitemperature) <br /> a Relinquished by <br /> name title data time <br /> Received by <br /> name title data time <br /> remarks (conditionitemperature) <br /> =iI 13 <br />