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Appendix H <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH <br />CHAIN OF CUSTODY RECORD <br />b 1 LL*V.— NS <br />1. Sampler's Name&CaL::rL TitlesRE11C Dept, <br />2 - <br />me Item Location LID# Unit Required Remarks <br />Analysis Condition/Temperature <br />� e1 (;V <br />3. Evidence tape lo <br />4. Sample transported in iced cooler <br />5. Relinquished by4 <br />name title <br />��-- l date time <br />Received b <br />name title date <br />/�e� time <br />LJ y 4 i4 As �- RF arks (condition/temperature) Gao ,mac -44 <br />6. Relinquished <br />ame title date <br />time <br />Received b g 2�SS <br />ame title <br />date time <br />remarks (condition/temperature) <br />cAle lalllvlbv� <br />75 <br />s <br />