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X33 -c,j <br /> Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL. HE.-kL.TH <br /> CHAIN OF CUSTODY RECORD <br /> Sr. RE}t 5 on m eK f 1 ftA, <br /> 1. Sampler's Name t Title Dept. G- L%tl Vlr <br /> 2. <br /> �llso�l awn�rc� �µS <br /> Date Time Item Lacation IDS Unit Required Remarks <br /> SW 1117aQ� Analysis Condicion/Temperacure <br /> ! �,l{w ess �1. Icyka.+ nor 17 Mgrs ambtbvl,4- }trvtpera#'u �� (, <br /> ! II I? II. M ILS Pir1C�l I `Jpr q.�..�s as' <br /> E� cart t t a <br /> II ISI II:p0�1M filKrpr�S 1 F3 Pencil labtewt +cw�pe- tui <br /> QQ �fXroksciKa�+ CAM 1-7,Mifj .(s }� — <br /> I �1-I 5A 2A Pyl jar tApthr.Fishbi - IIC wtb(.r✓v +C.wt atweI K- <br /> ll � Gq 6l. �.+'roKtsktE2zlc 28 ,;,al ��� " bmbl:�✓�t <br /> 150 Fcr'oKs su l ZG rIYd � ,t btu+ -. .i <br /> losAMe w[ 1 <br /> dr <br /> 3. Evidence tape, <br /> Ik <br /> 4. Sample transported in iced coole5K <br /> Relinquished by i SO'. R. S �� 1 <br /> me title date time <br /> Received b C� N3 /l` ��- 9 /l' L/ 14--t <br /> Anme <br /> title date time <br /> p h ie 74 ��M to <br /> remarks (co ndition/tem peracure) <br /> 6. Relinquished by' v r ,llf"d j 11 29.11CI I I PM <br /> e Lille� Z, date time <br /> Received by i <br /> e title dace time <br /> remarks (condition/temperature) <br /> EH 13 <br />