Chain of custody record, Westchester County Department of Labs

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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o co PAGE OF g OF LABS & RESEARCH

SDG# LABORATORY WESTCHESTER COUNTY U c o CT o NAME ADDRESS VALHALLA. NEW YORK o o' o CONTACT CONTACT _________________________ ■D o o Oi SAMPLING ANALYSES 3. ro LABORATORY SAMPLE PEST/ #0F PRESER- 91 Ca5 COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYP^ VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) O o 27770 Jian /Z /) t o c 3 CD ■y777.:2- Z 4 / 6 / 1 11

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I. SiAM^CQAM^EVINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN; PRINT: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM; DATE:, J, 3^01 TIME:|4|^ date: TIME:/zz,/^ DATE: TIME: DATE; TIME: h. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY; V. RECEIVED BY: /kNALYSES/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 EXPLAIN IN REMARKS BY;