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WESTOSTER COUNTY DEPARTMENT CHAIN OF cusTOr RECORD O
2 OF LABS & RESEARCH
PAGE OF CD
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CONTACT U 7
SAMPLING
LABORATORY
ADDRESS
CONTACT
WESTCHESTER COUNTY
VALHALLA. NEW YORK
ANALYSES
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o LABORATORY SAMPLE PESTI #OF PRESER- COMMENTS 0
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SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC )
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Kx 3 VMMFAMEIEa Pezble Q
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3
-6x88 22774 9s CD
mitto 22776 9f7
24590 22776
33550 22777
4/5050 22778 %
55 3950 22779
1. SAMPLED AND RELINQ. BY L RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: =
PRINT: V. It GO
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FIRM: Qf C. 7 . ,
saA2A.. SIGN:
PRINT:
SIGN:
PRINT:
DATE:(8leTIME: (o: :ssAte,timeaso FIRM:
DATE: TIME:
FIRM:
DATE: TIME:
II. RELINQUISHED BY: II. 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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