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Appendix•-H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> pp __rr CHAIN OF CUSTODY RECORD f , <br /> 1. Sampler's Name ��-S4&S h� Title _ S Dept. ��S E. I�• 4). <br /> 2. <br /> Date Time Item Location ID# Unit Required Rcmarks <br /> Analysis Condition/Temperature <br /> MUSna Z '� r ;r sic <br /> 3. Evidence tape <br /> 4. Sample transported in iced coo �+ <br /> 5. Relinquished b I a-465 �- 1/-9 f l/ /f, 50 <br /> name title date time <br /> Received b C.-� <br /> nam title date time <br /> rema (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by_ <br /> name title date time <br /> remarks (condition/temperature) <br /> D OCR M d ] - a <br /> EH 13 <br /> u�airelrJall:.ad�saa✓wl..✓✓✓rn:'l..l.!J.•:l.. ....�_. _ _ ✓___ _. ...:{.r:......:.'l.•.:.J:i.':._....�u.u......v.'1��:.�..�y� �.u. .. . � ... <br />