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• • Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's NameQ,;,,—&�4 Title Dept.- �S Fe,�,40 <br /> 2 <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/I'emperature <br /> t toy <br /> Cc [ [ [ ! 3/96 Q µ✓f 41 <br /> 3i9{µp <br /> Col-0 <br /> 3. Evidence tape m-----� <br /> 4. Sample transported in iced <br /> - cooler4 <br /> � t-1'i <br /> S. Relinquished by' ,• , -Ce,, 7153 <br /> name title date time �;o i5L--lc T.— <br /> Received by /G E 3 Z6�3 //-Dir-•• �G <br /> name title date time <br /> remarks (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by Y SGmO(� [oJk�(� , 03 a6 4? /.'.TTP <br /> name tiLli date time <br /> remarks (condition/temperature) <br /> EH__ 13 <br />