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Appendix H <br /> PUBLIC HEALT'ri SERVICES <br /> ENVIRONMENTAL F ALTH <br /> j�CHAIN OF CUSTODY RECORD <br /> I. Sampler's Name Q 7 isle �i tv Dept. <br /> Date Time Item L.ocauon ID# Unit Required Remarry <br /> Analysis Condition/I'emperaturc <br /> // <br /> P -o �� <br /> l 1 + <br /> I � <br /> � I <br /> + I I <br /> 1 l <br /> I I I <br /> I I I I I <br /> 3. Evident- tape <br /> 4. Sample transported in iced cooler Q <br /> 5. Relinquished b 4 -�,- r-� z 3d . �C 3 <br /> name title date time <br /> Received by { �- SaL�.i a o 3� <br /> A. <br /> m <br /> name title date time <br /> rcmarlcs (condition/temperature) <br /> 6. Relinquished by7 ,,, -7/3 ee 3 <br /> name title date time <br /> Received by 5 /C):/Soa'y� <br /> name title date time <br /> remarks (condition/temperature) <br /> Wdd ATL C Cd j C-f , 91D <br /> 0 � �'. <br /> EH <br />