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03/08/2004 08:57 20946R'�433 FIFTH FLOOR <br />PUBLIC-HEAL.T-ri SIrRViCrS <br />EcWYROKMF—N"rAL ki)—Z .TH <br />Ci%?,N OF CUSTODY RECORD <br />1, Sample: S Name t 'rile ' 'GS DeoL �J <br />2. <br />PAGE 01 <br />Ao acadix K� p l y <br />p Q. *'56LPD�A <br />Dstc <br />I <br />'i"ime <br />Item <br />Lcr,�tioa <br />IDS Unit Required Remarks <br />Aaalysis CoaditioniTemperaturc { <br />� 1 <br />� <br />6-c <br />Cr�C� 'Ac 5lo'1L.Q <br />i <br />l <br />1 <br />3. 'Evident- taps Q� <br />4. Sampta transported is iced coolar Q <br />5. Relinquished byCL.*�rz. \- a'a V5oo <br />name title date utas <br />Received by Q <br />name Citic date time <br />rcu=ks (coadWoaltemperature) <br />fi. Rctiugtiished by�d- <br />aawc title date time <br />EH <br />name vdate bare <br />rcmarks (coadirioahcraperature) <br />13 <br />D�� <br />