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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's NameTitle h EHS Dept.en%,- ron•yy—ty-n <br /> 2. <br /> Date Time Item Location ID# Unit Required Remark <br /> Analysis Condition/Temperature <br /> 2(� l"qQUICK BRR+CE 2325q�_ 77- 1rt1G ZZ <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler <br /> 20 <br /> S. Relinquished by f: I�.E.N S. S-2-q I0 an') <br /> name title date time <br /> Received by /6�4�57 Z-5-/ . <br /> name title date time <br /> remarks (condition/temperature) <br /> 6. Relinquished by � �/ �FGf 5 - 2 Z�/ �r <br /> /� p nme title date time <br /> Y <br /> Received b 6L( " S-Z Z"7( I Z ty <br /> M. <br /> name title date time <br /> remarks (condition/temperature) <br /> EH 01 17 14 <br />