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05/18/2004 08:44 2095720916 GED PAGE 06/06 <br /> Ap pend ix H <br /> PUBLIC HEALT-H SERVTCES 1 <br /> ENL VIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> I. Samp[cr'sName ,JT"stie Dept. �1ecfiE���c fT�rtL//f 63G1��L`i <br /> 2. <br /> Data 71m Item Locution ID# Unit Required Remarks <br /> Analysis Conditiow Tcutperature <br /> Gboo <br /> Kf,'6tu PA1 IL. s a< ! - <br /> t�PR I�IAI} <br /> o(L�/ f 5. atbJl�w � 7P <br /> A1Zr1w 6.a� <br /> A &at DA <br /> t <br /> 3. Evideacc tape <br /> 4. Sample transported in iced cooler <br /> 5. Relinquished by #&6LdL4-- <br /> . <br /> name title da time <br /> Received byAwgaouga <br /> t�llf (l ,F" <br /> as c title date tittle <br /> �44cmar=(co.nditionitemper.ature) <br /> 6. Reanquislted byAa <br /> .0 <br /> titles time <br /> Rived y v ` S <br /> name title dot `— <br /> rima <br /> remarks (conditionitemperature) <br />