2
K 2
o CHAIN OF CUSTODY RECORD K
3
o
WESTCHESTER COUNTY DEPARTMENT
OF LABS & RESEARCH
PAGEJ OF ) Q
CD
—
1 LABORATORY WESTCHESTER COUNTY
O SDG* 0
O
O
O
MME ADDRESS VALHALLA. NEW YORK C
O
N CONTACT CONTACT __________________ o
U
00 SAMPLING ANALYSES o
LABORATORY —
55s
00
SAMPLE PESTI #OF PRESER- comments 0
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC)
O
o
o
573 2141217- of 4,84 A C. C
3
CD
M:TZY: 211112 10/l Q,/2A 3
4350 H11- (0/6 7057 303/3
24750 ZHl10 WDLr’ $0327
3/0S0 441 (157 20334 &. t.
59350 20/1/ (00/ 3038% C.
788s0 2444718 Olh 303S7
125134349%8n02"=F9277
FIRM: DEP FIRM: 4 2 •
DATE:{oloooJIME:A DATE:l//TIME:/I28
-
ANALYSES/COMMENTS: IV. RELINQUISHED. BY:
SIGN229—
PRINT: ele-x
DATE-n/alon TME//5o
IV. RECH
SIGN:
PRINTS
FIRM:^i _
DATE: /?/o)TIME:/0500
ANALYSES/COMMENTS:
Vot
2445-428
II. RELINQUISHED BY: 11. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS:
SIGN:— j SIGN:WTRCMD SIGN: SIGN: fMj
PRINT: 2.0 7a
PRWTEggACamr Melals PRINT: PRINT: M3
FIRM: (2
DATE: fo // TIME, c DATE:
FIRM: 2
DATE: //a
FIRM:
TIME: / .AA DATE: 18/0 TiME-p*
III. RELINQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: Kuk CM> SIGNj SIGN: MU SIGN292f
PRINT: RutCamp PRINTEame
..... .............. PRINT: NP PRINT: sefns-
FIRM: SI" FIRM: ty
FIRM* L‘ P
DATE 9
O/G/0) TIME:je :4o FIRM*
DATE: 4042
/2/5, TIME/.% DATE://0c TIME4925 TIME4:2—
EVIDENCE SAMPLES TAMPERED WITH:NO YES N/A SAMPLES DISPOSED OF ON:
1 BY:
" ver MO "" P2*1 mr
OCR can misread numbers and units. Confirm readings against the page image before using them.