EFTA00029912

### EVIDENCE CHAIN OF CUSTODY

-

| Reason:              |                  | Reason:                     |                  |
|----------------------|------------------|-----------------------------|------------------|
| Printed Name/Agency: |                  | Printed Name/Agency:        |                  |
| Signature:           |                  | Signature:                  | Time             |
| Relinquished Custody | Date and<br>Time | Accepted Custody            | Date and         |
| Reason:              |                  | Reason:                     |                  |
| Printed Name/Agency: |                  | Printed Name/Agency:        |                  |
| Signature:           |                  | Signature:                  |                  |
| Relinquished Custody | Date and<br>Time | Accepted Custody            | Date and<br>Time |
| Reason:              |                  | Reason:                     |                  |
| Printed Name/Agency: |                  | Printed Name/Agency:        |                  |
| Signature:           |                  | Signature:                  |                  |
| Relinquished Custody | Date and<br>Time | Accepted Custody            | Date and<br>Time |
| Reason:              |                  | Reason:                     |                  |
| Printed Name/Agency: |                  | Printed Name/Agency:        |                  |
| Signature:           | Time             | Signature:                  | Time             |
| Relinquished Custody | Date and         | Reason:<br>Accepted Custody | Date and         |
| Reason:              |                  | Printed Name/Agency:        |                  |
| Printed Name/Agency: |                  | Signature:                  |                  |
| Signature:           | Time             |                             | Time             |
| Relinquished Custody | Date and         | Reason:<br>Accepted Custody | Date and         |
| Reason:              |                  | Printed Name/Agency:        |                  |
| Printed Name/Agency: |                  | Signature:                  |                  |
| Signature:           | Time             | Accepted Custody            | Date and<br>Time |
| Relinquished Custody | Date and         | Reason:                     |                  |
| Reason:              |                  | Printed Name/Agency:        |                  |
| Printed Name/Agency: |                  | Signature:                  |                  |
| Signature:           | Date and<br>Time | Accepted Custody            | Date and<br>Time |
| Relinquished Custody |                  | Reason:                     |                  |
| Reason:              |                  | Printed Name/Agency:        |                  |
| Printed Name/Agency: |                  | Signature:                  |                  |
| Signature:           | Time             |                             | Time             |
| Relinquis            |                  | ANSEDICT Clistour           | Date and         |
| Reason:              |                  |                             |                  |
| Printed N            |                  |                             |                  |
| Signature            |                  |                             | Time             |
| Relinqui             |                  |                             | Date and         |
| Reason:              |                  |                             |                  |
| Printed N            |                  |                             |                  |
| Signature            |                  |                             | Time             |
|                      |                  |                             | Date and         |
| Relinqui             |                  |                             |                  |
| Printed N<br>Reason: |                  |                             |                  |
|                      |                  |                             |                  |
| Signatur             |                  |                             | 1 31 000         |

This form is incomplete without reference to the FD-1087.