Chain of custody record, Westchester County Lab, Nov 2001

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ouuw I r DEPARTMENT CHAIN OF CUSTODY RECORD -0 OF LABS & RESEARCH PAGE__ L OF__ I c J =o

i SOG# LABORATORY WESTCHESTER COUNTY -a o NAME ADDRESS VALHALLA, NEW YORK p- CONTACT CONTACT ______________________ o o SAMPLING agMiLYSfeS S

I LABORATORY SAMPLE FEST/ »OF PRESER- COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN 3 BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) cc — 3.

W0- l^toSD III J.33SO HI 3/^ 2,^1 2c=l

5^ £42. II IQlZifc. friQ-SD 3 (Z 2.552 l0:03 '2Y75?

2^1^o l(|24- EZIKZE^iZ I I. SAMPl^QAN ELINQ. BY I. RECEIVED BY;. ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN; SIGN: SIGN; PRINT. PRINTZA/A^-- PRINT; PRINT: FIRM; FIRM; u FIRM: FIRM: 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;