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2
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CHAIN OF CUSTODY RECORD
3 WESTCHESTER COUNTY DEPARTMENT O
OF LABS & RESEARCH
PAGE OF CD
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1
o LABORATORY WESTCHESTER COUNTY U
o SDG# C
o
o NAME YC -DEP ADDRESS VALHALLA, NEW YORK O
N
CONTACT. 2 M orvS CONTACT __________ ;_________________ o'
c U
O. SAMPLING ANALYSES o
COMMENTS
N
LABORATORY SAMPLE PEST/ # OF PRESER- - —
0
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.) O
CATLEFDT 2 l 11 ol 0830 (kab 3. o
Q
C
3
DeUI 2478 1012 0l 0)00 (olable 18 CD
CRo@H 2470 10120l 1000 AHable ,2 ■ |O
I. SAMPLED AND RELINQ. BY 1. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS:
SIGN: 2W. Love® SIGN. SIGN: SIGN:
PRINTS. vJ. Roov ~s— PRINTS PRINT: PRINT:
FIRM:H*0DC{
FIRMGF./ _ FIRM: FIRM:
DATE:^,^|0| TIME:31S DATE://2/, TIME:/3725 'DATE- TIME: DATE: TIME:
II. RELINQUISHED BY: 11. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: 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:
EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:
IF YES EXFGR IN REMARKS BY:
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