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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name lfiin (A Title Dept. <br /> 2 <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/I'emperature <br /> IQ Ipntss P'P,^fwrt . 5_I S,,.P�Z <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler <br /> S. Relinquished by'LorQC-7 <br /> ''��ff��f� title date time <br /> Received by ����� <br /> n title 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 />