Laserfiche WebLink
Aocendix K <br /> PUBLIC HEALTH SERVICES �c <br /> ENVIRONMENFTAL H"c�[.'I H <br /> :�5U <br /> CHAIN OF CUSTODY RECORD <br /> I. Sampler's Name yjv*,�, Dcot. <br /> Date Tim a Item Location M# Unit Required Remarks <br /> Analysis Co adition/Temperacure <br /> I <br /> I I I <br /> I I I I I <br /> I I <br /> i I I <br /> I I I I I <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler Q <br /> 5. Relinquished bye \S ` �'`�S �I� O� I%kacx:) <br /> name title date ume <br /> Received byRo¢- <br /> name title date time <br /> remarks (coaditianitemperature) , <br /> a Relinquished by,))r-)& Ata h k H1 � bt 3 50 <br /> name title date time <br /> Received by &66L CGS.,,,n <br /> name tie data c <br /> remarks (condiuopltemperature) <br /> �2e1�",%u;sh.eA '0/, F2;c�,rc�. Cin��r. IJN�t 9_g-oL+ -t-i v.� <br /> R�ceiU-9J l3� `a°� o q-8-6`l 2:SO <br /> FE__ 13 <br />