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Chain of custody form, Westchester County Labs, undated

Machine-extracted title · confidence 90%

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

NYC-WTC_000026864–000026871

Folder label: “23833

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Scanned page image, NYC-WTC_000026864
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2 - 2 o west3®ter county department i CHAIN OF CUST ‘RECORD PAGE Pr / - 2 OF LABS & RESEARCH O CD — o 1 SDG# LABORATORY WESTCHESTER COUNTY o "0 9 o o o NAME A AZYEYSi to) ADDRESS VALHALLA, NEW YORK C O N CONTACT CONTACT o' O. "0 00 O. SAMPLING ANALYSES o — LABORATORY SAMPLE PESTI o..#OF PRESER- COMMENTS 0 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN “$7 BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) O ■.............. "I " o Q 213 2 38 3 2 YXFMMZTMn C 3 CD

WSTTn:] "E.TEU 9/18 9:5% 20 97 0413 p HEE-eM 1 S L wXTEiel Eo-GWEEAEi —2353- 9 001- 9/11 (10 L. I 1 7837 EZMKSHEEYME&AHIE"M T | 22030 I I I EEnLNyem EGESHEAW”T2) 2383“

1. SAMPJERZPZEHNC By 1SIGN: REC ANALYSES/COMMENTS: IV. RELINQUISHED. BY: SIGN: IV. RECEIVED BY: SIGN: ANALYSES/COMMENTS:

PRIN:BrisGerkc PRINTS PRINT: PRINT: FIRM: wYC2fP , _ FIRM: t FIRM: FIRM: DATE: %2%7TIME:/342. =============== DATED Ol TIME// 20 DATE: TIME: DATE: TIME: II. 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: 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:

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NYC-WTC_000026864Source: NYC Law Department, mirrored locally

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Record documenting sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

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