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. Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH C r� �J ffi 0i6VA <br /> CHAIN OF CUSTODY P#5 RECORD( C !HH <br /> I. Sampler's Name ,158 r0 Title �r• �• Dept. -' D <br /> 2EN 5 <br /> Date Time Item Location ID* Unit Required Remarks <br /> Analysis Condition/I'emperamre <br /> 2/0,43 /1:/5 <br /> <br /> <br /> <br /> <br /> <br /> <br /> Clu-Z -!°-D$ plas�lri <br /> 3. Evidence tape g/ Sfored Ill SZ OI/C17Z! / /(�( 5 <br /> �Q� U3I f,Ull�w(,Q. � d' 11lf <br /> 4. Sample transported it. iced cooler (� <br /> S. Y Relinquished Relinq b ^ �u�� " l' <br /> �=�?fS G /� i -2) <br /> name title date time <br /> Received by_ <br /> name title date time <br /> EVII'�Pt'�G:'. +/'iDF' i2Cr?./f?d iai� f�'f�J'Cav� <br /> remarks (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH13 <br /> `^J <br />