Chain of custody record, Westchester County Department of Labs

z WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o z OF LABS & RESEARCH PAGE I OF 1 co s SDG# LABORATORY WESTCHESTER COUNTY so NAME CONTACT ADDRESS CONTACT VALHALLA, NEW YORK _________________ ___ c o' 'o "0 o o SAMPLING ANALYSES I o zu O • LABORATORY SAMPLE TEST? insF PRESER- COMMENTS 03 o SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION 03 (SPECIAL INSTRUCTIONS. CAUTIONS. ETC | a o cn o cn ZyTViF Il i 74 c 3 o 7777^ 3-

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I. SAW ’LED AND RELINQ. BY I. RECEIVI BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN? SIGNrf^ SIGN: SIGN; PRINT;- PRINT—T" ) PRINT: PRINT; FIRM: t>CS. P FIRM: I . FIRM; FIRM; DATE:vi^q\o< TIME:L0'A5 DATE^^^XnlrJIMEJ^ i DATE; TIME: DATE; TIME:

II. RELINQUISHED BY: II. 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: I SIGN: PRINT: PRINT: PRINT: PRINT: FIRM; FIRM; FIRM; FIRM: DATE: TIME: DATE: TIME: DATE: TIME: DATE; TIME:

5 EVIDENCE SAMPLES TAMPERED WITH;

IF YES EXPLAIN IN REMARKS NO YES N/A SAMPLES DISPOSED OF ON:

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