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7� ��F� -a �f — Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMEIN TAL HEALTH <br /> CHAIN OF CUSTODY RECORD y <br /> 1. Sampler's Nam t I az$W i6CAS Dept. �,�1 `����3 L. !,ZZ� <br /> f <br /> 2. <br /> f <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis ConditioniTemperature <br /> r A. <br /> I-F <br /> 3. Evidence tape <br /> 4' <br /> 4. Sample transported in iced cooler [j <br /> S. Relinquished byc � �w— <br /> name ti le date time <br /> Received by 0CL51:., 2,j2 <br /> name U tit a date time " <br /> stir �r <br /> rcmarks (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (conditionitemperature) <br /> 4.a <br /> EH__ 13 <br />