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Chain of custody record, Westchester County Lab

Machine-extracted title · confidence 100%

Document tracking the custody and handling of environmental samples submitted to the laboratory.

NYC-WTC_000027414–000027417

Folder label: “24429

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Scanned page image, NYC-WTC_000027414
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-- A— SM 4 2 K O CHAIN OF CUSTODY RECORD 2

3 o WESTCHESTER COUNTY DEPARTMENT OF LABS & RESEARCH PAGE_____ OF K O co I SDG# __ LABORATORY WESTCHESTER COUNTY *: O o o NAME NYC DEP kesis ill ADDRESS VALHALLA, NEW YORK “0 C o N CONTACT ey a . Les A-Mrvis _n m CONTACT" . , . . O o SAM LING m ---------PEST/E ANALYSES “0 LABORATORY ------- SAMPLE go”y #OR PRESER­ COMMENTS o — SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS, CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC? 0 Q+ Lec 1224u20 iolS]o/ 091 3 t O o Q C 3 CD

De! IS 20020 70/370/ /056

PooCiE 2441 loJSjoi /0/5%

1. SAMPLED ANDRELI I. RECEIVED BY: ; . IV. RELINQUISHED. BY: IV. RECEIVED BY:. . ANALYSES/COMMENTS: SIGN: DLeckeouel o । CHY YA Ah-— SIGN: SIGN: PRINTS %an< /irct , ro 1—7—J AUSMv) PRINTS ----- PRINT: PRINT: FIRM: OyE - P ResS/co 4 FIRM: U Illii FIRM:Aamdnd FIRM: “ATE:// -TIM E//JYSTDATE: tols/oTIME: K« DATE: P TIME: DATE: 'TIME:

. .3 *..2 II. RECEIVED BY: ' ANALYSES/COMMENTS: v. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: '■SIGN: SIGN: PR,* PRINT: PRINT: PRINT: FIRM: ~ RM: FIRM: FIRM: DATE: , TIME: LATE: TIME: DATE: TIME: DATE: ’ TIME:

!!, Pel 2 == e. UI. REC 1 ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN: . . SIGN: =R|.’cr- PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: "ME: SATE. TIME: DATE: ■ TIME: DATE: TIME: DATE: 1 * I EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:

IF YES EXPLAII^y EMARKS ! S-

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NYC-WTC_000027414Source: NYC Law Department, mirrored locally

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

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