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05/30/2006 11: 35 2095720916 GEO PAGE 11/11 <br /> Appendix H <br /> PUBLIC HEALTH SERVICESi <br /> ENVIRONMENTAL HEALTH 1 <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's NamesTitle LS.R�Depu <br /> , t. t- TG �L D <br /> 2. <br /> Date Time item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> glf. OJ 1d4M 1-114 ioi <br /> �b ID, -:2 - 2 aa ' fl2 <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler <br /> S. Relinquished b42=: � efL <br /> n e t le Q to time <br /> A. <br /> Received by <br /> lime/ title date u e <br /> �_... remarks (condition/temperature) <br /> 6. Relinquished by �.�-�✓s �--- <br /> name titie date tim <br /> l .gj1 s �����Received by ('&,* ,d.L T_ __,L-aa'�., <br /> name title date um <br /> remarks (condition/temperature) <br /> EH__ 13 _! , OL <br />