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Chain of custody record, Westchester County Labs, undated

Machine-extracted title · confidence 85%

Westchester County Department of Labs and Research chain of custody form documenting the transfer of environmental samples.

NYC-WTC_000026753–000026756

Folder label: “23697

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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:

*"

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NYC-WTC_000026753Source: NYC Law Department, mirrored locally

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NYC-WTC_000026695 · Box DEP Box 19

Westchester County Department of Labs and Research chain of custody form for environmental samples submitted by the City DEP.

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