Laserfiche WebLink
• . <br /> PUBLIC HEALT'ri SERVICES Appendix H�J Q <br /> ENVIRONMENTAL. HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> I. Samoler s Name L _'TIBC .5;O Dept. <br /> Date Time Item Location ID4 Unit RequiredRemarks <br /> Analysis Condi[ion(Iempereture <br /> Z O I / I SC�e� t3tl`� I ) Cpm s'1 vw c�wC C -Fw- <br /> i I IN 2 ! <br /> I i <br /> ! <br /> 3. Evidence tape`, <br /> 4. Sample transported in iced cooler* <br /> S. Relinquished by A_G WS �Ot <br /> title date <br /> �/ time <br /> Received by , � ��`1 <br /> *aae title date time <br /> re t ( ition/temperature) / <br /> a Relinquished by <br /> name 71 Lille d, time <br /> Received by Jti I 0 164 1 <br /> title da time <br /> remarks (condidoo/temperature) <br /> EH IS <br /> � �r5ln bia 45ias/ <br />