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10 Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name h 4ea Yt,,)r^ Title JciJ, of lF F 1t S DepL PHS-EHL <br /> �r-4- <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition(remperature <br /> It 1$13 J)P- 1A N,2e4&- <br /> Iii 5 F . A,�✓ a5 i c 111??3 DP jK8 To Dc-*,,..eL?/4�4. DM-7—,L- <br /> 3 c fIgY3 fit' i4 z�t' � �rr4�c� <br /> 3. Evidence tape 1. <br /> 4. Sample transported in iced cooler Q <br /> S. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> 6. Relinquished by <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (conditionitemperature) <br /> EH__ 13 <br />