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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name �O ' �4Title 1`� F S Dept. �� f�S �-4 D <br /> Date Time Item Location ID# Unit Required RemarksAnalysis Condition/I'emperature <br /> 9�ry�3 :00 L 193 o I �� 1 f/ v b <br /> •• O 9 3orA y L v P <br /> 30,o] �?y°3os C'tA <br /> 3. Evidence tape, fes/ we JJ/S 7,"a <br /> 4. Sample transported in iced cooler 74/S / /� / £ S��Y le <br /> S. Relinquished by! ��5/7C <br /> name title date time <br /> Received b 41 /,)A— <br /> name title <br /> remarks (condition/tempemLure) <br /> 6. Relinquished by <br /> name title <br /> date time <br /> Received by <br /> name title <br /> date time <br /> remarks (condition/temperature) <br /> IV-) CD env <br /> EH-- 13 <br />