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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name" &LAr Title Dept. <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis ConditioruTemperature <br /> 3. Evidence tape [] <br /> 4. Sample transported in iced cooler <br /> 5. Relinquished by 14Lr), tar2L71S <br /> title date time <br /> Received by y"" s% /i�i�� �/u-93 y�� ►, <br /> n title T date time <br /> rks (con [ion temp�yramre) ` <br /> 6. Relinquished by <br /> name title 6476' date time <br /> Received by LS4Ck, AwA')tt e,f/ I, II <br /> name title date time <br /> remarks (condition/temperature) <br /> EH__ 13 <br />