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j<333 -off <br /> Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> LCXI}ia OrS SREFS <br /> 1. Sampler's Name 9 Tir.tle Dept. C- Enol ,onrrlevtfzt.l }fmfi'rl <br /> ft{Iso n Q�W crrl EItS <br /> Date Time Item Location M* Unit Required Remarks <br /> 5Wtll74q— Analysis CondWon/Temperature <br /> 11 I? I : M �ilkrpress IA ,„�c,1 RJAr+ 94MF 'sabtsambuvtt +t*vi <br /> 11 17 Il:p filkrPr� I Q Finial tKtrr t t ctnabtewt +c.npe..-.crxr <br /> 11 Mfu rows sutR+k 2 A Poo ar+ CAM hsuals <br /> bbt P wr+cwt <br /> II 1 T1q ►f. �rrowsstaRtU' 2B SAID t' btawlt <br /> I I{ {5�M FrrrvKssul ZG <br /> Me <br /> djorr 1 � <br /> r <br /> 3. Evidence tape' <br /> 4. Sample transported in iced cooler <br /> Samf)(O-c�:Relinquished by i S0. R. <br /> 4me <br /> title date time <br /> Received b d ni3 //- I7-S9 title date time <br /> ,A.Imhiem-" tEwo <br /> remarks (condition/temperature) <br /> 6. Relinquished by <br /> e title CZAZI date time <br /> Received by 1 � L <br /> e title date time <br /> remarks (condition/tempemture) <br /> EH 13 <br />