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09/23/2005 06: 44 209572091E GEO L PAGE v5/09 <br /> 09oendix H <br /> ewlRocrtita*+Ta,l. sur.-c �e'P� <br /> CHAti I OF CUSTODY RECORD <br /> I.Sample;s Name1 Title Deoc. - P-F-(Q <br /> Date Puna Item (tee tion I @ Unit Required Remarks <br /> Aaatysis Conditioall'cmperaturc <br /> s <br /> Sot lUt J lr.eNS F JPS 4;y F N� G <br /> 751 ► � I I f <br /> �I <br /> 3. Evident: tape Q <br /> 4. Samote transported to iced cooler Q <br /> 5. Relinquished by � t In� �!� 2� <br /> name title date drne <br /> Received by , I A6 <br /> me title date time <br /> rcn=L-. (condidonkemperaturc) <br /> a Relinquished by <br /> acme otic date time <br /> Received by <br /> name [fele data time <br /> remarks (condidaaltemper'ature) <br /> Eci__ 13 <br />