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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE [ OF 7
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o OF LABS & RESEARCH
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N SDG# LABORATORY WESTCHESTER COUNTY
co NAME gCD CP ADDRESS VALHALLA. NEW YORK E
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CONTACT
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LABORATORY
SAMPLE NO. SAMPLE NO. DATE
SAMPUNG
TIME
SAMPLE
TYPE VOA BNA
PEST/
PCB
WVLYSES
METALS CN $*
#OF PRESER-
BOTTLES VATION
COMMENTS
(SPECIAL INSTRUCTIONS, CAUTIONS. ETC)
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268 aq5 10/2 9,26
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30960
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0829
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J.152 75777 ((24
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$119 21055 t (Orp Hot
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I. SAMPLED RELINQ. BY I. RECEIVED ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY. ANALYSES/COMMENTS:
SIGN: _15-O / SIGN: SIGN: SIGN:
PRINT: V.CELo PRINTLC%_ PRINT: PRINT:
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DATE to
lUISHED BY:
11. RELINQUISHED BY:
11. RECEIVED BY:
ANALYSES/COMMENTS:
FIRM:
DATE: TIME:
V. RELINQUISHED BY:
FIRM:
DATE: TIME:
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:
EVIDEN PLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:
IF YES EXPLAIN IN REMARKS BY:
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