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NAME
LABORATORY
ADDRESS
WESTCHESTER COUNTY
VALHALLA, NEW YORK
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DATE;i, jT-o / 01 TIME: |34'O TIME:^.yo 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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