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Appendix H <br /> PUBUC HEALT-H SERVICES <br /> FNVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Samoler's Narne&-& Title ��ff� Depc. y(1%�c�l/� �/#c �►c rff � �� <br /> Date Time [tem Location, M* Unit Required Remarks <br /> Analysis Conditionfremperature <br /> L d w oc.Kfijt�o PA , <br /> 1 L- Lt//S LUPT <br /> meT��s 6� CAl l7 3 <br /> SPA 6010is <br /> i� <br /> at 4-Y t+305. JL&JRJ^ T'Ep{ - �err, santt•� <br /> �a :5a w sT' Yo*a Z I L a WP-1- (�AC._K-u f �6 <br /> G4A17 1 <br /> � I I <br /> 3. Evidenc:, tape <br /> 4. Sample tmnsportedxin iced cooler <br /> S. Relinquished by 9N�w <br /> name title dati ume <br /> Received by I- A _! + <br /> as a [itle date time <br /> 1 <br /> ' cmar {coaditioaltemperature) . <br /> 6. Relinquished by Cl <br /> me title date rine <br /> ReceivedCJL4 q E-Z-- <br /> Y <br /> name tide6 <br /> 1E& time <br /> remarks (condidOn/temperature) <br /> EH_._ 13 ! <br />