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v <br /> Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name (ti Title Dept. <br /> 2 <br /> DateTime Item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> IR bass PP^t ,�,i . 5_1 <br /> i� —1 <br /> ,XS <br /> 3. Evidence tape [] <br /> 4. Sample transported in iced cooler <br /> S. Relinquished by �ZwroreE7 fS 1 U 9� _ <br /> name title date time <br /> Received by <br /> name 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 />