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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name t4Ji (5dn Title ZEE.5 Dept <br /> Date Tune Item Location M* Unit Required Remarks <br /> Analysis Condition/I'emperature <br /> 141/30IZ5-b <br /> fsaM r �Sol/ <br /> sd pQ�y� QQa�san- <br /> �i/ <br /> s+n� e� " .tr c�z"�Q¢QC <br /> /—tr- li o u W G�t.vY�err.4 <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler <br /> S. Relinquished b4,A,— lLy, <br /> / title date time <br /> Received —9S 3�(� <br /> name title date time <br /> remarks (condition/temperature) <br /> 6. Relinquished by <br /> name Lille date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH__ 13 <br />