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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_000027886–000027942

Folder label: “25037

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Scanned page image, NYC-WTC_000027886
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2 2 - - o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE_ Lor_] O co 2 OF LABS & RESEARCH — "0 o SDG# LABORATORY WESTCHESTER COUNTY C 1 o o o NAME MUCDR ADDRESS CONTACT VALHALLA, 71^7 YORK O o' o CONTACT U N o 00 SAMPLING ANALYSES — 0 00 LABORATORY SAMPLE PESTI O. #OF PRESER- COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC) o Q C »v»zy. mtn EEKY." 3 CD

0,58 253% y 8:15 A 149s0 0/2. 0447 Aer”M 2525031144 ' 1240 1.5040 30s0 31203 HHKy-M G-oM 1 (szs0 / 2./ 6 SEPN — /o Yd -9 , KYLom 53/90 71226 350 3

I. SAMP D AND RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: J SIGN:/Y) SIGN: SIGN: PRINT: MY ' ACoUB PRINT/c PRINT: PRINT: FIRM: I DATE: EP DEP TIME: jC:ZsA FIRML4 TIME: 02 . FIRM: DATE: TIME: FIRM: 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 5d ( Rrs BY:

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NYC-WTC_000027886Source: NYC Law Department, mirrored locally

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