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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name LT BP� qc?S Title Sent&Z Dept. ?/q S <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> oe <br /> <br /> <br /> <br /> <br /> la- -un, X U,u C ZA 7'0 C.!!i <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler [] <br /> 5. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> .80-7`k A r Ot ks�condiationa�per tore 5P/4 '�' 44 1 a- Aq --A-Pr,1,T F -S <br /> 6. Relinquished by +,?/.lei /-/�{� 11-12 'r'-3 Z 2 - --2,n <br /> name Vy title date time <br /> Received by �!^( ` ,12-2 q q? , /( _ Z, D <br /> name title date time <br /> remarks (condition/temperature) <br /> EH 13 <br />