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Appendix H <br />Ll -7 I -14 - <br />PUBLIC HEALTri SERVICES <br />ENVIRONISENTAL. HEALTH <br />CHAIN OF CUSTODY RECORD( <br />1. Samoler's Name Ti[le� a `t i S DeoL P' 1 S E <br />rl <br />Date <br />16 4b <br />Time <br />Item <br />Location <br />M* <br />Unit <br />Required <br />Analysis <br />Remarks <br />Conditionll•emperature <br />I�-Oppe-Sr <br />ri s <br />�� -!ir a� <br />I V`i+i <br />GLP� <br />foCtSh.w� <br />y <br />it <br />LtSb-� .coal <br />,C <br />,t Ifi <br />.� <br />ML J -L rol It m=7 46� <br />o <br />I � <br />I <br />I <br />I <br />I <br />I <br />l'91 -70s - <br />L".1 1 <br />7oS <br />L. a-1 70(Q <br />3. Evidence taoe� <br />4. Sample transported in iced cooler rq <br />S. Relinquished by kch + "' &-&L Bm, RF- 0G- 6 . 10 �.3o <br />iia -pep title date time <br />Received by i WAO IY\. b/ ti ��S (p - 1� •t7C) LO '. ,f V� <br />name title date time <br />w 6 <br />U rcmarks (condition/temperature) <br />a Relinquished by fl oA L s (D- -OD 1Z,.CXD-P" <br />name vtitle date time <br />Received byY-�g (160 l4 -I, I� ' c P <br />aaW title date time <br />remarks (condiLIC nit= Odra Lure) <br />EH 13 <br />