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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> C N OF CUSTODY RECORD <br /> CAb <br /> 1. Sampler's NamTitle Dept. S. �, P A S- 14 D <br /> FDate Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperaturee <br /> �fo-t s <br /> N/ ,ll"6 I(� <br /> .1 <br /> 5 <br /> -tTG �1 G U <br /> 7v <br /> 3. Evidence tape 'f t arty <br /> 4. Sample transported in iced coole r.A - box, q <br /> 5. Relinquished by #Lk4jC , <br /> na i flcc. tyle date time <br /> Received by rJ 2 AA,4 - NGX. <br /> name title date time <br /> room teen o , a <br /> T remarks (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH___ 13 <br />