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11 <br />0 <br />Appendix H <br />CHAIN OF CUSTODY RECORD <br />I. Sampler's Name "Title Dept. <br />2. <br />Date <br />Time <br />Item <br />Location <br />ID# <br />Unit <br />Required Remarks <br />Analysis Condition/Temperature <br />lie <br />3. Evidence tape' <br />4. Sample transported in iced cooler n <br />S. Relinquished by a � G.4twjs- ' 0 - C 7 -aE . Dq �-D <br />n;dne title date time <br />Received by e! Z, %17 1r, �2 <br />name title date time <br />remarks (condition/temperature) <br />b. Relinquished y Vl Q A LT,– �J .2 <br />/name title A date time <br />Received by *— c c +%' Z - Z� Pi e <br />na a title date time <br />remarks (condition/temperature) <br />EH _ _ 13 <br />