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Appendix H <br />?LBLIC HFAL77H SERVICES <br />EVVIRON,MF— NAL HEALTH <br />C: Lk"N OF CUSTODY RECORD <br />1. Sampler's Name Title <br />2. <br />Date <br />Tune <br />Item <br />Location M* Unit <br />Required <br />Analysis <br />Remarks <br />Conditioa/Temperature <br />i 14 <br />wiz <br />j�of� /tA3 <br />I { I <br />I <br />' <br />I <br />I <br />I <br />I <br />{ <br />I <br />I <br />I <br />I <br />I <br />i <br />I <br />I I <br />! <br />r <br />3. Evidence tape <br />4. Sample transported in iced cooter 91/ <br />S. Relinquished by i % <br />name title date cim <br />(p,,, `i -t <br />Received by Ir <br />name title date time <br />® <br />C, �:-- (ot, — 7 , "o -'o <br />remarks (eoaditionitemperature) 'If, <br />6. Relinquished by <br />name title date time <br />Received by <br />name title date time <br />remarks (coaditionitemperature) <br />Mi _ _ 13 <br />