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Appendix H <br />PUBLIC-HEALTEH SERVICES <br />ENVIRONMENTAL AL HEAL TI -I <br />r <br />CHAIN OF CUSTODY RECORD <br />1. Samole,s Name Titles Dcor. S�ov0 <br />2. <br />Date <br />Tune <br />Item <br />Locadoa <br />ID# <br />Unit <br />Required <br />?.aalysis <br />Remarks <br />Co nditio n/Tempera Lure <br />3. Evidcncr tape Ri <br />4. Sample transported in iced cooler Q <br />5. Relinquished byM—�'S Q 'is \'S o`-� \Soo <br />name title date time <br />Received by — a 3 0 \St-> O <br />same title date time <br />remarks (coadidoa/temperature) <br />b. Relinquished by <br />aamc title date time <br />Received by <br />aame title date time <br />EH <br />remarks (cc adidoaltemperaLure) <br />li <br />