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Chain of custody form, Westchester County Dept of Labs, Oct

Machine-extracted title · confidence 95%

Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000027804–000027811

Folder label: “24944

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2 - O S -I 2 I o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE [ OF 7 - o o OF LABS & RESEARCH O © O O N SDG# LABORATORY WESTCHESTER COUNTY co NAME gCD CP ADDRESS VALHALLA. NEW YORK E o CONTACT 2 CONTACT . o'

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) I resnnssunanee (X 268 aq5 10/2 9,26 A4 1 20?s0 30960 w 3(022 1o fn oli) toltt /212

0829

/o‘4

41 +90 J.152 75777 ((24 EEEAI $119 21055 t (Orp Hot J491%--

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:

EzKgucttskzm,zdznup. rrmOE.C 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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NYC-WTC_000027804Source: NYC Law Department, mirrored locally

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NYC-WTC_000026432 · Box DEP Box 19

Record documenting sample transfer and custody for environmental testing at the Westchester County Department of Labs & Research.

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