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- WESTCHIFER COUNTY DEPARTMENT CHAIN OF CUSTO ECORD -
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2 SDG# LABORATORY WESTCHESTER COUNTY 3
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NAME C- DEP, ADDRESS VALHALLA, Lie’s YORK
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LABORATORY SAMPLE PEST/ SOF —
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN 5215 BOTTLES PRESER-
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COMmenTs
(SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) 0
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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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