2 2
K
o
WESTCHIGR COUNTY DEPARTMENT CHAIN OF CUSTODGECORD t <
o
2 OF LABS & RESEARCH I'.
PAGE CD
—
o SDG# ___________ _ LABORATORY WESTCHESTER COUNTY
1 "0
o
o
o
NAME NGCNeP
CONTACT •
ADDRESS VALHALLA. NEW YORK C
O
o CONTACT o'
N "0
O. •
CH SAM PLING ANALYSES o
O.
O.
LABORATORY
SAMPLE NO. SAMPLE NO. DATE TIME
SAMPLE
TYPE VOA BNA
PEST/
PCB METALS CN Sks #OF PRESER-
BOTTLES VATION
*
comments
(SPECIAL INSTRUCTIONS. CAUTIONS. ETC)
—
0
o
o
212 2954 I EXAW 2 Q
C
3
CD
Hy 2% 233L0 9l24 9AA,
1
I. SAMPLED AND RELINQ. BY I. RI ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN:- f SIGN: SIGN:
PRINT:
VISLAo
FIRM: .E,Y
3/240/T
FIRM: 02 M
DATE 9/240/TIME: /Ofo DATEg4l0)TIME:(04
...
PRINT:
FIRM:
DATE: TIME:
PRINT:
FIRM:
DATE: TIME:
II. 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:
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000026566Source: NYC Law Department, mirrored locally