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Appendix : i <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL Hi— TI -I <br />CHAIN OF CUSTODY RECORD <br />t� t <br />I. Samples NPH- Came Title _ N S Depc l �- <br />fl <br />7 <br />Date <br />I 16 <br />Time <br />Item <br />L=Lioa I <br />m-* <br />Unit <br />Required <br />Analysis <br />Remark <br />Condition/Temperature <br />t <br />iyLlS <br />l3 -l4 CCS <br />G <br />GU7 <br />ti PcikSlu" a <br />'► <br />�„l.Q, <br />"�� <br />i� <br />Lab-Ib.�a�� <br />V <br />I <br />3. Evideact tape y <br />4. Sample transported is iced cooler Q fta-(—rk r/, (f�, rypy i f� <br />0 " G� ,t <br />S. Relinquished by )Qfin+iM-s o�uAB7 �� tLl s . 6- 'NU I d x.30 <br />ttam� title date time <br />l <br />Received by I� (C lel .t7Ci I� <br />acme title date time <br />W 6, <br />/0 remarks (conditionitemperature) <br />a Relinquished by R l 4DOA �,t�5 <br />name j vtitle date time <br />Received by5v �°ao <br />mawtitle date time <br />remark (condidoaltemperature) <br />EH 13 <br />