Chain of custody record, Westchester County Lab, Nov 2001

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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o o CD OF LABS & RESEARCH PAGE OF § c o o SDG# NAME CONTACT MVC - LABORATORY WESTCHESTER COUNTY ADDRESS CONTACT VALHALLA, NEW YORK _________________________ ■D c CT o' o ■D o o SAMPLING ANALYSES 3. KJ LABORATORY SAMPLE PEST/ #OF PRESER­ COMMENTS 91 KJ SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC ) O o / ? Io G I L 'F, < o c 3 CD 05X1 /A 1

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I. SAMPteeW^RELINQ. BY ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN; uJ. SIGN: SIGN: PRINT b. iJ. i-- PRINT PRINT: PRINT: FIRM: FIRM: IMx J FIRM: FIRM: DATE: TIME; PATE-|||t^/t/TIME;KpO 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/COM M ENTS; 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: