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Document / 66 pages

Sample submission form, Aug 2001

Machine-extracted title · confidence 90%

Form used to submit environmental water samples to Westchester County Laboratories with chain of custody documentation.

NYC-WTC_000025775–000025840

Folder label: “22166 - 22171”

Page image
Scanned page image, NYC-WTC_000025785
OCR text

OCR status: ok · source: pdftotext

Z K o eeroi@% COUNTY DEPARTMENT S CHAIN OF CUSTOIRECORD Z - -I 1° OF LABS & RESEARCH PAGE O © o — O O o SDG# NewYock Cay DEP LABORATORY WESTCHESTER COUNTY N NAME ADDRESS VALHALLA. NEW YORK C U 01 CONTACT CONTACT ________________ CT co o C SAMPLIN ANALYSES U LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS O • SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.) 0 O o DMAMCC Q C 3 CD

4

2210 7,

UNNKPE

1. fTFS48RP&==8 BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM? FIRM: DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:

11. RELINQUISHED BY: 11. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN: SIGN: PRINT: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:

III. RELINQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN: SIGN: PRINT: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:

EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:

IF YES EXPLAIN IN REMARKS BY:

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NYC-WTC_000025785Source: NYC Law Department, mirrored locally

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