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Appendix H <br /> LP# I l Z y PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH -47 <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name Dept. ;VPNs-61/ <br /> 2- <br /> Date <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/I'emperaLure o <br /> �r..t,�13 c <br /> 90 <br /> buss <br /> 6 j z:�/a,Q•, Ser/ �r. G✓,'so -�� <br /> -B bass <br /> 7 <br /> Gb ,So:/ a'Z S. W, U c <, <br /> nrss <br /> 3. Evidence tape>� <br /> 4. Sample transported in iced cooler, <br /> S. Relinquished b 61318 3 : /S-- Prti <br /> name title date time <br /> w Sf <br /> Received by 4,0r : <br /> nam tit a date time <br /> remarks (condition temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH__ 13 <br />