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AploendU H <br />PUBLIC HEALrrf SERVTC:_S <br />FLNVIRCNMFNIAL HEALTIH <br />CHAIN OF CUSTODY RECORD <br />I. Samplers NameZLIZI-M Title Xln6 DeCt. -Elz� <br />2. <br />Date <br />I <br />i <br />Tarte <br />item <br />Location <br />ID <br />Unit <br />Required <br />Analysis <br />Remarks <br />Condition/Temperature i <br />' <br />ri <br />I <br />i <br />I I <br />I <br />I I <br />I <br />I <br />i <br />i <br />I <br />3. Evident:, caoe (}/ t <br />4. Sample transported in iced cooler Q/ <br />5. Relinquishedby <br />title dace ume <br />Received by b 'a -C l.f -InCk 5--a-p) S:5---5 <br />nn <br />4title date time <br />/L/csy Zsyi`i^° S ��uQ �`-a�., /�-- - tf Ldp y S7L� C. /� <br />remarks (condition temperature) <br />a Relinquished by <br />name title date time <br />Received by <br />name title date time <br />remarks (condidoa/temperature) <br />EH__ 13 <br />