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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”

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Scanned page image, NYC-WTC_000025780
OCR text

OCR status: ok · source: pdftotext

2 2 - o 2 weerci® ER COUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTORECORD PAGE OF - O co — o I U O SDG# LABORATORY WESTCHESTER COUNTY C O O O N NAME JYCDEP Kensico Lab ADDRESS CONTACT VALHALLA. NEW YORK ______________________ CT o Cl CONTACT U O co SAMPLING ANALYSES • O 0 LABORATORY SAMPLE PESTI #OF PRESER- COMMENTS O SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION Iz- (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) o o FFAICK Del,(Y. 1:oDAM lalale C 3 CD

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I. SAMPLED AN RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: 1W. Kowe SIGN.s7 r SIGN: SIGN: PRINT: D.W KoC~s~ PRINT: Edeno PRINT:; PRINT: firm: /C 'her FIRM: les FIRM: ? FIRM: DATE:Aizot TIME: 116 DATE-9 It'Z'fOl TIME-/:0 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_000025780Source: NYC Law Department, mirrored locally

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