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PUBLIC-HEALTFiI SERVTCES <br />ENVIRONNT—NTAL. FEALTH <br />CHAIN OF CUSTODY RECORD <br />1. Samoler's Name bG. Title <br />Appendix H <br />o�OK <br />Date <br />I <br />Tittle <br />Item <br />Location <br />M# <br />Unit <br />Required <br />Analysis <br />Remarks <br />Condition/Temperature <br />I <br />I I <br />i <br />i <br />I <br />I <br />I <br />3. Evidence tape R! <br />4. Sample transported in iced cooler Q <br />S. Relinquished by MV -J \'- Q�`'CS \'S o�-\ �SC� <br />name title date ume <br />Received by <br />acme title date time <br />remarks (coadition/temperature) <br />6. Relinquished by wews <br />name title date time <br />Received bvC� . j� � �Vf_ — r\. e I3L <br />name title date time <br />EH <br />remarks (coaditioa/temperature) <br />13 <br />r'� <br />