MM12-31E-MM-108062 SEC 001 SER 1-70-000010 EFTA00099692 • Chain of Custody FD-192 d Case ID . : 31 - - • Accepted By: Printed Nam Reason:..Collecte Date T me:... . .. ) .... Accepted By: Printed Name• Signature- Reason- Date/Time• Accepted By: Printed Name• Signature- Reason- Date

tents O RH Signature of Seizing • Req. Charging O Freeze • Refrigerate Printed Name/Agcn • E Biohazard Reason: Initial Collection O Other Collecte I B Agency: I- -,/-; j Relh Date and Time Accepted Cu Date Sign Prin eh i f ti /0! v su te ited Signature: N l± Reason: re a t ti Rea