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Chain of custody form, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

Record documenting sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

NYC-WTC_000026351–000026358

Folder label: “23258

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Scanned page image, NYC-WTC_000026351
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OCR status: ok · source: pdftotext

2 2 - O 2 o WESTCH@ER COUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTODRECORD PAGE 1 - o co — 1 o SDG# _ LABORATORY WESTCHESTER COUNTY "0 C o o NAME UCDef ADDRESS VALHALLA. NEW YORK O o CONTACT_________ __ CONTACT o' N O. "0 00 SAM PLinG ANALYSES o

as CH — LABORATORY SAMPLE PESTI #OF PRESER- COmmenTs 0 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC.) O o Q

Bx3 23255 q/2] C 3 CD

6153 23251 9/2) /3SO 28511/2320 WTUS) WEEE-ire] 25524/23% 9/20 26582/232 2%/20 (0%l 28suSs4 > 9/20 724$ S12s0 2.35192327*/ 20 I1O7 41350- 419o 0294 44

I. SAMPLED RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN====<>----- * SIGN:- ,( SIGN: SIGN: PRINT: V , lleC2 PRINT6-/0a . PRINT: PRINT: FIRM: 0.5,7. FIRM: 49 FIRM: FIRM: DATE: 9/21o/TME:/@(o DATE:f/24/00 TIMH:48 DATE: TIME: 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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NYC-WTC_000026351Source: NYC Law Department, mirrored locally

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Record documenting sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

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