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AppendU K <br /> ( - d -7 <br /> PUBLIC HEALTIH SERVICES <br /> aNV1RO NUENTAI. <br /> CMN OF CUSTODY RECORD 35�a3� <br /> 1. Samole:s Name wC-Ttie V-'ZA'C-no Deoc. <br /> Date Time Item Location M* Unit Required Remarks <br /> Analysis ConditioniTemperaLure <br /> I <br /> I <br /> I I i <br /> i <br /> 3. Evident: tape <br /> 4. Sample transported in 'ced cooler <br /> 5. Relinquished byD: <br /> name title date time <br /> Received by c� �� �� \3c-)o <br /> acme title date time <br /> rcmarks (coaditionitemperature) <br /> b. Relinquished by — — '' a� <br /> aame title date time <br /> Received b S�,pa . -o 3 12 3 <br /> aara —title date time <br /> remarks (condidoaitemperature) <br /> < <br /> E� 1a <br /> �C G� <br />