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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name Title 7,e�4C Dept.en\,,rpnrro�nt - Ajw4 <br /> 2 <br /> Date Time Item Location ID# Unit Required Remark <br /> Analysis Condition/Temperature <br /> ZD l icl QUICK Br?,44CE 2325" <br /> I rT1G ZZ <br /> 3. Evidence tape [}' <br /> 4. Sample transported in iced cooler <br /> �c <br /> S. Relinquished by A- i <br /> name title date time <br /> Received by �J <br /> name .� title date time <br /> •����.� S7��v,�e Jic.�z� <br /> remarks (condition/temperature) <br /> 6. Relinquished by L ;L/K - � <br /> �� title date time <br /> Received by '^LC ZZ"7( tZ". toyM. <br /> name title date-e time <br /> remarks (condition/temperature) <br /> EH O1 17 14 <br />