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Appendix H <br /> PUBLIC HEAL.T'rrT SERVTC <br /> ENVIRONMENTAL 'ET'H <br /> j CHAIN OF CUSTODY RECORD <br /> I.Sampler's Name2 Ticle_-1. <br /> DepL lel <br /> Date T"tme Item Location ID# Unit Required Remark { <br /> Analysis Coaditionfl'emperature <br /> I <br /> `' Cpm t1 <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler Q <br /> 5. Relinquished by)— .�,v 3d �j . �/ 3 <br /> name title title date time <br /> Received by12 ({�-_ J - �ww.ig6& a/O3� g 3� <br /> name title date time <br /> t <br /> 1 remarks (coadition/temperature) <br /> 6. Relinquished by <br /> i <br /> name title date cime <br /> Received by <br /> I <br /> name title <br /> data time <br /> remarks (condition/temperature) <br /> i <br /> I <br /> I <br /> EH <br /> i <br />