- -* A Z
K
2
. .... .. . . : 1 •
O
-
O WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD ' o
g OF LABS & RESEARCH WU——00111/YVa PAGE_____ OF______
U
o SDG# LABORATORY WESTCHESTER COUNTY
C
O
l
o
o NAME NyCDEPBWS Se Co A—6 ADDRESS VALHALLA. NEW YORK o
o U
o CONTACT. Ues /, M2s CONTACT O
N
0) SAM PUNG . »
#OF .—COMMENTS _
©
CD LABORATORY SAMPLE PEST) PRESER o
CD o
SAMPLE no. SAMPLE NO. DATE TIME TYPE VOA BNA ' PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.)
2
Ce-ZcT 22432= 20/0/07 2/:36 3
CD
5-
De/ /9 2173/ 20/0/0/ 7/: / 6
C206r 24730 20//00/
cue
tilt
IPLED AND RELINQ. BY I. RECEIVED BY:
1. SAMPLI ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BYT ANALYSES/COMMENTS:
PRNTSKJACWALUPPR... S GN:
PRINT: .
SIGN:
PRINT: II
FIRM://1/ C EP Kengico 4 ‘FIRM:
DATE:t//0/0/ TIME:220 1
DATE:///o/v/TIME/212a 5RM: TIME:
FIRM: •
DATE/ TIME: aa
.RELINQUISHED BY: IL RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: v. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: SIGN: SIGN: —0099*
PRINT: PRINT PRINT
FIRM:
DATE: , TIME: DATE: TIME:
ANALYSES/COMMENTS:
BRM
VI. RELINQUISHED BY:
FIRM;
DATE: TIME:
III. RELINQUISHED BY: ED BY: VI. RECEIVED BY:
SIGN: 1127 SIGN; SIGN:
ANALYSES/COMMENTS:
11 It It । / ic Miadu n
PRr.r.
FIRM:
PRINT:
FIRM:
PRINT.
FIRM:
690
am
PRINT:
FIRM:
mam
I DATE: 2.55: DATE: TIME: DATE: TIME: DATE: TIME:
f - : EVIDENCE SAMPLES TAMPERED WITH: *2 5 .t SAMPLES DISPOSED OF ON:
MM
Je IF YES EXPLA’WPEMARKS
a BY:
1.
•...........
1
OCR can misread numbers and units. Confirm readings against the page image before using them.