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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name l:fea b o r - !FP _ P5 'Et-{ D <br /> A <br /> 2. <br /> Date Time Item Location 1D# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> 1A !C19 dr-lbu�F;Z <br /> 1119?3 DP pa <br /> fo <br /> 14- /- <br /> N L.3 0 <br /> I1 6�S ;2;3c7 <br /> .41 <br /> 3. Evidence tape <br /> 4. Sample transported in iced cooler <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 ------j - <br /> name title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH 13 <br />