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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> L?rN hGt f3i- s <br /> 1. Sampler's Name t '-� Sr. RE}H s Title Dept. C- 1~✓1✓J r0 P1 Me'1 }fca lql�j <br /> 2. <br /> ftliso� ate �HS <br /> Dace Time Item Location ID# Unit, Required Remarks <br /> SW 1117 q— Analysis Candition/Temperacure <br /> Ifw es6 1 t,3gerf M 1?"!.9 GtrnbLd-n - +twwatu <br /> 111111 I I: M IAP,riG�1 Jar 94M,.; a.l <br /> 117 II:pQAM filfceprd� 1 &411 'aew it Iaeobt.2wt +cr"pe.-afm <br /> �trroKs SwgLfr- r' q.Karfi firm 1.7 b4iMj& Q`rib(2wt- +cwt cztwel <br /> 2 A Q�rtG�l ,ar A�eMr. <br /> Il 1 Gq 11: -vroKSZw,lFa,lc 28 "gal s t, I <br /> f�.�nbtirt�- <br /> 1 '°Ks s u t 2G Vj,v .A,- <br /> 111 i ri o ,t r r -1.Mz <br /> I dbai wC I <br /> r � <br /> I I <br /> 3. Evidence tape' <br /> 4. Sample transported in iced cooler <br /> SampW-c�:Relinquished by <br /> B's -te, : title date time <br /> Received b ame vs //- /7-9 •ys <br /> almev title date Lime <br /> Afh1 h i C vt t tf-t7n,2 <br /> remarks (co ndicton/temperaLure) <br /> k4j; <br /> 6. Relinquished by' e, j 1!' 1��� . 1:15N <br /> e title ((-?fti J date time <br /> Received by i S��L' /�'Zcl% q /5 4A <br /> e title date time <br /> remarks (condition/temperaLure) <br /> R <br /> EH <br />