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t `4Appendix K <br /> � 4 PUBLIC HEALT'rI SERVICES G- `I <br /> ENVIRONMENTAL 1fi TH _�`>t't `;;�cj��i` I� �¢` `'IEAI.1Ii <br /> X13 :C.'Rly1IC, <br /> CHAIN OF CUSTODY RECORD <br /> c <br /> 1. Sampler's Name 2 Tit03 AUG -7 PM 4: 33 <br /> le li Deoc. <br /> Date Tune Item Location ID* Unit Required Remarks <br /> Analysis CoaditionlI'emperature <br /> I'1� 1/0 11:5 5 CPA 11 i7 Z U <br /> i l I I <br /> I <br /> I <br /> i I I <br /> i <br /> I, f <br /> i <br /> f I I M <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler Q <br /> 5. Relinquished b '� Z 3d - c 3 Y <br /> name title date a time <br /> Received by[3e4Na_Z 3R, Awn <br /> name title duct time <br /> rcmarks (coaditionitemperature) <br /> 6. Relinquished by ,c4,�,, CD,,, ,.T 5"e", . 43 a 3 <br /> (� name title 0 date time <br /> Received by�1���nIl�d,(Yk AQ -r-m, no 03 <br /> name title �� date time <br /> remarks (condidoaltemperature) <br /> EH__ 13 <br />