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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_000025778
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document Date: (-1-0 / 9-12-6/ New York City Department of Environmental Protection Kensico Laboratory Day: Tuzedey — led nday KeypolntBhaln of Custody Form I ORBOTTLES COLLECTED t, Ty. J. £ t 3 2 a 3 o .2a X • S p 5 8I 8105 6 I P E 1 8 m § S$ £ s DE 2s 38 $ o s avi 52’ s m o

SITE LOG NUMBER TIME o 38 • wn .

006 2 s8 o “ E = (2 E 4 ly‘ Q. c

I&ATLEFF 63/8 2330 l 4 i l 1 DEL18 632. Ol 00 I I 1/1 1 I I CATEV DELI 9 DEL17 OATALUM CROGH 638 0215 I 1 1 / BkBR&P 326 1 LeA&R 63 24 6328 I =EEE 638 1 llenesw G3S PBG188/ " pfo as 6329 1 +

NA me 6330 Pc ms 6331 Vo A MB 6330 |

HgDUP HgMB । PCBDUP PCBMB COMMENTS:

RECEIVED BY CHEMISTRY: a/p( c Relinquished by: ' Sample is: . Date/Time RECEIVED BY MICRO: RECEIVED BY INSTRUMENTS: (A )) 6322- *e200g04 6330 (000 ok&k (Date/Time) (Date/Time)

Relinquished by: Sanka ss?S mela baterrimo RECEWEDBYcEsTAWWesr. Cly. RECEIVED BY MICRO: RECEIVED BY INSTRUMENTS:

, 3*-Y*eeBd‘ &-ldenc z r /filo ! 7-26.4R 1o1 no -9 (Date/TIme) (Date/Time) (Date/Time)

airsOr Sample "si Date/Time RECEIVED BY CHEMISTRY: RECEIVED BY MICRO: RECEIVED BY INSTRUMENTS:

(Date/Time) (Date/Time) (Date/Timne)

•"All samples collected. preserved, and transported according to Division SOP guidelines.

J NYC-WTC_000025778

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NYC-WTC_000025778Source: NYC Law Department, mirrored locally

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Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs & Research.

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