Laserfiche WebLink
Appendix H <br />PUBLIC HEALT-H SERVTCES <br />ENVIRONMENTAL H'EALT'H <br />CHAIN OF CUSTODY RECORD <br />I. Samoler's Name 2e. Title y � Depc. <br />2. <br />LN3?-/'? <br />Date <br />Time <br />Item <br />Location <br />ID-* <br />Unit <br />Required <br />Analysis <br />Remark <br />Condition/Temperature <br />Z A <br />2Z <br />I <br />I <br />I <br />i � I <br />I <br />( <br />� <br />I <br />I <br />I <br />3. Evidence tape <br />4. Sample transported in iced cooler (� <br />5. Relinquished byy <br />title date time <br />Received by �� ���� 5-r7'0y <br />na title date time <br />PM7 <br />ndition/temp4rature) <br />a Relinquished by �� r kt H- 5 —i 7 —O c� y' L6— <br />name /- title dace time <br />Received byL / t=' ' 5 1- U D q `� S <br />name title date time <br />remarks (condidoNtemperature) <br />EH 13 <br />672.13 cl, <br />