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SDG# __________ . LABORATORY WESTCHESTER COUNTY ■D
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CONTACT
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VALHALLA. NEW YORK
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asmPUNG _YSES 3.
03
4^ LABORATORY SAMPLE PEST/ lOF PRESER- COMMENTS
tn SAMPLE NO. TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC) o
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LSAMMOi^ 1. RECEIVED BY: ANALYSES/COMMENTS; IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS:
SIGN: SIGN: SIGN; SIGN:
PRINT: f®lNT; PRINT; PRINT;
FIRM: iQY^-jTtL/H^rH-s'pIRM: FIRM: FIRM:
TIME; 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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