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4 Appendix H <br /> PUBLIC HEALTrI SERVICES <br /> aNVIRONNiHNTAL EEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Samoles Name Tile�ead Sr�C—t rS Dept 16rNV. (4-ta,f4Fl— <br /> Date Time Item Location M# Unit Required Remark <br /> Analysis Conditionl7emperature <br /> i <br /> l°l:�t( V3 AlS Io4 14 P <br /> A r ZZ Z <br /> I I <br /> 0 <br /> 3. Evidence taoe (� C�� 2(p 0 P2 � ���( V2710 5 <br /> t.t Gl Cwt C� IYILt LJV r 2/A <br /> 4. Sample transported in iced cooler <br /> S. Relinqu�hed y u�;2 52 ' ( z( <br /> name title date time Ct , <br /> Received by 10 2 o g: 2 3 l <br /> name title date time <br /> remark (condition/temperaLure) <br /> a Relinquished by t7 'i--e .Z <br /> name title date time <br /> Received by .� `� 2t/ <br /> /f name title date time <br /> V - u ;5marks (conditioNtemperat re) <br /> 0�1 <br /> �c ✓P.� GJ /2�35/�� �e' ea y, <br /> � e13 <br /> ,�` L�ti� <br />