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Appendix H <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH <br /> CHAIN OF CUSTODY RECORD <br /> 1. Sampler's Name {J Title .S S� Dept. <br /> 2. <br /> Date Time Item Location ID# Unit Required Remarks <br /> Analysis Condition/Temperature <br /> / <br /> /0.7-3 <br /> �' l� i2 3 S LU /0-735 <br /> o-7,3 +� <br /> 3. Evidence tape <br /> 4. Sample transported in iced coole <br /> S. Relinquished by <br /> name title date time <br /> Received by g, � die�L- <br /> 4ae <br /> name title time <br /> remarks ( ndition/temperature) <br /> 6. Relinquished by/v <br /> ame title date time <br /> Received by <br /> name title date time <br /> remarks (condition/temperature) <br /> EH__ 13 <br />