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Chain of custody record, Westchester County Lab, Nov 2001

Machine-extracted title · confidence 90%

Chain of custody form for samples submitted to the Westchester County Department of Labs and Research in Valhalla, NY.

NYC-WTC_000070918–000070927

Folder label: “28855

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z o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD lO

OF LABS & RESEARCH PAGE OF § LABORATORY WESTCHESTER COUNTY -0 c SDG# CT O ADDRESS VALHALLA, NEW YORK o' o NAME o CONTACT CONTACT _________________________ ■0 o o o 3. co SAMPLING ANALYSES 03 LABORATORY SAMPLE PEST/

i N3 #OF PRESER- COMMENTS O SAMPLE SAMPLE NO, TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC ) o o c hl ZIW 2122 J 3 CD 3 ——

/I / I)/ I. SAMA^D.ANDBe^ffi.BY I. RECEIVED BY: ANALYSES/COM M ENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS. SIGN: SIGN: SIGN: SIGN: PRINT: c PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE: TIME: DATE: TIME: DATE: TIME: II. RELINQl/sHED 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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NYC-WTC_000070927Source: NYC Law Department, mirrored locally

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