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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_000026945–000026954

Folder label: “23900

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Scanned page image, NYC-WTC_000026945
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2 2 K WESTCHESTER COUNTY DEPARTMENT I CHAIN OF CUSTODY RECORD PAGE LOF/ K o o OF LABS & RESEARCH 2 SDG# LABORATORY WESTCHESTER COUNTY CD — o 1 o o NAME pACIIP ADDRESS CONTACT VALHALLA. NEW YORK __________ :___________ "0 C CT o CONTACT 7 o' o N SAMPLING ANALYSES "0 O. O CD LABORATORY SAMPLE PEST/ 9% BOTTLES PRESER- COMMENTS — CH SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC) 0 O o +2 930 9/29 Q C 3 CD 6 58 2340/ Qt2oA.

130 SO 2442 9/73 0389 7-3^02-^ 250S0 74420 /OS3 x<

34450 2349750 O04R 530S0 235947 23905 113S 24500 1HL 23706

1. SAMPLED AND PELINQ. BY 1. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: PWNT: MAKeAMYACOL SKRNF.27784 SIGN: PRINT: SIGN: PRINT: FIRM: DEP FIRM: 0, FIRM: FIRM: DATE:I /29 ol TIME: 0:A DATE924,, TIMEJd:/8 DATE: TIME: DATE: TIME: 11. 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: T IF YES EXPLAIN *MArre BY:

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NYC-WTC_000026945Source: NYC Law Department, mirrored locally

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NYC-WTC_000027107 · Box DEP Box 19

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

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