Chain of custody record, Westchester County Labs, Nov 2001

CHAIN OF CUSTODY RECORD ■<

WESTCHESTER COUNTY DEPARTMENT PAGE I OF I o S' OF LABS & RESEARCH

SDG# LABORATORY WESTCHESTER COUNTY -0 9 ADDRESS VALHALLA. NEW YORK c NAME CT CONTACT CONTACT o'

I ■0 sampling iWLYSES o LABORATORY SAMPLE PEST/ #0F preseR- 3. DATE I TIME COMMENTS SAMPLE NO. SAMPLE NO. TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC | O o o c 3 T I I o o

T T 1 I T 1 I

I I I JeS. I I 2.2'lzUn 1 I 1 I I 9 S'!? U 6 I I I A£Z

I. SAMI ID INQ. BY I. RECEIVED BY:. ANALYSES/COMMENTS: IV. RELINQUISHED. BY*. IV. RECEIVED BY: ANALYSES/COMMENTS: sign: SION: SION: ............. - .X- PRINT: PRINT:/f../^X4, PRINT: PRINT: FIRM; 7>£? FIRM:t-/A FIRM: FIRM: ,PATE;//^2^IME;4/^^/? GATE; TIME: DATE; TIME: DATE: TIME:

II. REUNQUISHED BY: II. RECEIVE BY: ANALYSES/COMMENTS: V. REUNQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS; SlGNSf71/a{VW>l-- SIGN*,!? SION: SION; PRINT;/fc/l/j^l6nn PRINT:U^CLa PRINT: PRINT; ■1 FIRM: FIRM; FIRM: D^TE:i/fe/on»ME:7^ DAT&Wjg.-'^ TIME:T.^ DATE: TIME: DATE: TIME:

III. REUNQUISHED BY: III. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS; SIGN: SIGN: SION: SION: 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: