NYC 9/11 Public Portal Document
! a 1____
' WESCHESTER COUNTY DEPARTMENT CHAIN OF CUST RECORD
OF LABS & RESEARCH PAGE OF
SDG# amgyama 0 J < .a,: LABORATORY WESTCHESTER COUNTY
NAME NC-E0- Kesico Lol ADDRESS VALHALLA, NEW YORK
CONTACT 2 MlovoS CONTACT
-
__ ______________________
* :
/ . ANALYSES .. \ T
SAMPLING
LABORATORY SAMPLE 6 PEST/ PRESER- COMMENTS
SAMPLE NO. SAMPLE NO. DATE , TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.)
Ag-Z--— 2677, Q 9:45
11 2767 ol 0 10100
(L - 10349% 1300
r
7 -26/
I. SAMPLED A (opON !. BY I. RECEIVED Y: A
SIGN: J
ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN:' SIGN: SIGN:
Mtcc PRINT:Uc8C
PRINT: Voce 40 V 1' - invi PRINT: PRINT:
FIRM: Yc0z0-Kewslu FIRM:. C4%
LslC FIRM: P FIRM:
DATE: I TIME:g:1 DATE: qP7o/TME81S a* DATE: TIME:
FIRM:
DATE: TIME:
l. 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: 0 DATE: TIME: DATE: TIME:
III. RELINQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS:
SIGN _____ SIGN: —— 00400—0760/ SIGN:
0 o
SIGN:
PRINT:
FIRM:
n FIRM:
PRINT: m PRINT:
FIRM:
PRINT:
FIRM:
————01
DATE: TIME: DATE: TIME: DATE: TIME: DATE: TIME:
....... nt........... .................. ... V
IDENCE SAMPLES TAMPERED WITH:____ NO YES N/A SAMPLES DISPOSED OF ON:
IF YES EXPLAIN IN REMARKS BY:
*"
NYC-WTC_000026753
OCR can misread numbers and units. Confirm readings against the page image before using them.