Chain of custody record with sampling details, Westchester County

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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o CD OF LABS 4 RESEARCH PAGE OF

“0 SDG# LABORATORY WESTCHESTER COUNTY C I NAME cl/} ADDRESS VALHALLA, NEW YORK- CT

I CONTACT SAMPLING CONTACT ___________________ __ ANALYSES o' "0 o

§ LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS 9L O SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN ■BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) o o c 756^ 5 o 3

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I I. SAMPLED RELINQ. BY I. RECEIVED BY; , ANALYSES/COMMENTS; IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS. SIGN.;.,s,--‘=^-P^ ‘ SIGN: SIGN: PRINT; V , I iGtA? print/<,/V!/U^l/$^ PRINT: PRINT: FIRM: e,/. FIRM: WiL FIRM: FIRM: DATE: TIME: PATE: ,,/^/^,TIME:/^C^ 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: