EFTA00123424

## U.S. Department of Justice

EVIDENCE CUSTODY DOCUMENT

<table><thead><tr><th>OFFICE</th><th>CASE #</th><th>LOG #</th><th>DATE AND TIME OF SEIZURE</th></tr></thead><tbody><tr><td>NAFO</td><td>2019-010614</td><td>3</td><td>8/13/19 16:00</td></tr><tr><td colspan="2">PROPERTY SEIZED FROM</td><td colspan="2">LOCATION OF SEIZURE</td></tr><tr><td colspan="4"></td></tr><tr><td>ITEM</td><td colspan="3">DESCRIPTION OF THE PROPERTY SEIZED</td></tr><tr><td>$\textcircled{1}$</td><td colspan="3">Weekly SHU signature sheet</td></tr><tr><td>$\textcircled{2}$</td><td colspan="3">SHU visual search log</td></tr><tr><td>$\textcircled{3}$</td><td colspan="3">Attorney log book</td></tr><tr><td colspan="2">NAME AND SIGNATURE OF WITNESS</td><td colspan="2">NAME AND SIGNATURE OF SEIZING SPECIAL AGENT</td></tr><tr><td colspan="4">CHAIN OF CUSTODY</td></tr><tr><td>ITEM</td><td>DATE/TIME</td><td>RELEASED BY</td><td>RECEIVED BY</td><td>PURPOSE</td></tr><tr><td>1-3</td><td>8/13/19 8:47</td><td rowspan="6" colspan="2"></td><td>outpatient room</td></tr><tr><td>1-3</td><td>8/13/19 9:30</td><td>open door for review</td></tr><tr><td>1-3</td><td>8/19/19 02:34</td><td>RAPID</td></tr><tr><td>1-3</td><td>12/11/20 0:30</td><td>New Enrollment Checking</td></tr><tr><td>1-3</td><td>12-19-24 11:15am</td><td>Return to case agent</td></tr><tr><td>1-3</td><td>12-19-24</td><td>Transfer to (Final) JOD</td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

OIG FORM III – 234/1 (04/23/07)