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• • Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIR0NMI FNTAL H"cALTIH <br /> CHAIN OF CUSTODY RECORD <br /> I. Samoter's Name �Q;fk r0(a, Title Sri S Dept. 6Ey. (—E.ea.+t— <br /> o <br /> Date Time [tem Location M* Unit Required Remark <br /> Analysis ConditioniTempertture <br /> 'qz-dc, V3 AlS (off [ <br /> t�(2 tlo g`l£�I ted eft A r Z- <br /> I � <br /> i <br /> 3. Evidence tape <br /> 4. Samole transported in iced cooler <br /> 5. Relinquist by <br /> name tide date time <br /> Received by <br /> name title date time <br /> remarks (condidowtemperature) <br /> a Relinquished bye ,__, 0 2� 9'•Z 5-2, <br /> name �� title date time <br /> Received by N `� Oo ��2 } <br /> name title date time <br /> hvi mark (conditionitemperature) <br /> Ap <br /> �y Vrr iii "- �0gu�j tl <br /> I / A9-%I 3 <br /> �__ 13 1% i'U KAP <br />