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Appendix H <br /> PUBLIC HEALT'rI SERVICES <br /> aNVIRONMENTAL HEALTH <br /> L I fo i <br /> C.�c AN OF CUSTODY RECORD <br /> . <br /> 1. Sampler's Name `S� <br /> lopeTitle /f S Deoc � is M s, -�- <br /> l S. Ce,/l oW 57ac '9��v <br /> Date Time I= Location M* Unit Required Remarks <br /> Analysis Conditionrl'emperature <br /> c <br /> 9-601 1 a;3 o J %v 7 f- mes T-r - � rc w <br /> s <br /> -00 j� '.3o1 °�' �l�r IMera2s I �lb <br /> CAm ( 7 <br /> lir <br /> `! <br /> 3. Evidence caoe)( <br /> 4. Sample transported in iced cooler E 14 C) <br /> S. Relinquished by ,_SO, j:UZR E i4_S ' _ 11910 3r J <br /> me title date time <br /> Received by <br /> me , title date time <br /> r ks (coaditio tetnpe Eur <br /> a Relinquished by <br /> name title date time <br /> Rec:ived by 6' l2 <br /> title date time <br /> remarks (condition/temperature) <br /> EH I3 <br />