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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE 3 OF H co
g OF LABS & RESEARCH
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LABORATORY WESTCHESTER COUNTY c
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o NAME ADDRESS VALHALLA, NEW YORK o'
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o CONTACT ftAorTEF CONTACT _______________________ "0
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sampling LYSES 9L
LABORATORY SAMPLE PEST/ #0F PRESER COMMENTS O
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN —J
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I. SAMPtf&AWB-RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: SIGN?-€»--^. SIGN: SIGN:
PRINT.-V.mO, PRINT: PRINT: PRINT:
FIRM:PyC -bS P FIRM: br^ FIRM: FIRM:
DATE:H/^jo^ TIME:|^<0 DATE:/z^^ TIME:/y«^^ 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: 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:
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