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Chain of custody form, Westchester County Lab, Sep 2001

Machine-extracted title · confidence 95%

Document tracking the chain of custody for environmental samples submitted to the Westchester County Department of Labs & Research.

NYC-WTC_000026447–000026451

Folder label: “23318

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Scanned page image, NYC-WTC_000026447
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2 2 - WESTCHIFER COUNTY DEPARTMENT CHAIN OF CUSTO ECORD - O o OF LABS RESEARCH PAGE 2 SDG# LABORATORY WESTCHESTER COUNTY 3 co — o 1 o o NAME C- DEP, ADDRESS VALHALLA, Lie’s YORK "O C O o CONTACT CONTACT o' o N SAMPLING WVLYSES "0 O. o LABORATORY SAMPLE PEST/ SOF — SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN 5215 BOTTLES PRESER- VATION COMmenTs (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) 0 O o 1X 3 *22225 9/23 7:4/Ar o C 3 1X5% 32 4/23 V/SAM CD

I. SAMPLED AND RELINQ. BY I.SIGN: RECEIVED BY: / ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:

SKTNY.askenYYA c uA FIRM: DeP: , 300 /94 PRINT:///k

DATE:9/23/o TIME:/Am FIRM:022-7/*R DATE$/2s/TIME/>w SIGN: PRINT: FIRM: SIGN: PRINT: FIRM: DATE: TIME: DATE: TIME: II. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: SIGN: YWS1— SIGN: AT SIGN: SIGN: PRINTLMAysM PRINTWO FIRM: LS Nclo’s PRINT: FIRM: PRINT: FIRM: ERMAADpToyTIME lo1^ DATE:q/a/a\ TIME: jous DATE: TIME: DATE: TIME:

III. RELINQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: SIGN: Jut/ SIGN: . SIGN: SIGN: PRINT:Moy PRINT: PRINT: PRINT: FIRM: wC FIRM: FIRM: FIRM: DATE^ ^/q, 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_000026447Source: NYC Law Department, mirrored locally

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