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04/08/2004 12: 17 2095726 GEO PAGE 14/14 <br /> Appendix H <br /> PUBLIC HEALTH SERVICES <br /> EXVIRON,A.IFSIT'AL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> I.Sampler's Name,l &Wt Itle S 4LUC.�-_ Depc <br /> Date Tune Item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> e , I,seo ,sit <br /> Ca^ `S� -F <br /> 2 U,'8 <br /> I <br /> I <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler` <br /> S. Relinquished by Ij S fp l "YZ <br /> dim <br /> title date time <br /> Received by �?rf date <br /> �+ a dile <br /> time <br /> cc ar ( ition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> title dat <br /> time <br /> remarks (conditictAcmperature) <br /> FH 1' (IQdUDz ILt t n <br /> � �a/n bra cass� <br /> ® TCCf g O, L70 80-1 5)5) <br />