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t a x4P ; <br /> Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECON <br /> 1. Sampler's Name Title rtvoDept., yw&1-,4n,4ijiR9tYIt11f <br /> 2. <br /> ffa It= LAMLionM# Unit -Rgqwm4 rks <br /> Analysis Condition/remperature <br /> --o � �� ° 't-tis�►y°ass '���:� s; �h � - <br /> - <br /> 0A <br /> 'ttUS �• �+►-tR <br /> 3. Evidence tape <br /> 4.Sample transported in iced cooler <br /> 7a���s� <br /> S.Relinquished by �Mk4W�rwpw V-1 <br /> Warne title date k time <br /> Received by �.c.k b �6s' rte, S t•w <br /> name tit date r <br /> remarks (conditionitemperature) <br /> 6. Relinquished by 7,,h,.:i C 6c, S,. vle.f 3:23 <br /> name : titie dale time <br /> Received by ?,�, : 23 <br /> name title data time <br /> remarks (conditionitemperature.) <br /> EH .. 13 <br />