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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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OF LABS & RESEARCH
i SDG# LABORATORY WESTCHESTER COUNTY -0
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NAME ADDRESS VALHALLA, NEW YORK CT
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CONTACT CONTACT _____________________ ■0
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SAMPLING ANALYSES 3-
LABORATORY SAMPLE ■PCSTT JOF PRESER- COMMENTS
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTfiUCnOMS. OUtlOCiS. £1C ) O
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1. SAMPLED AND RELINQ. BY 1. RECEIVED BY; , ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN.------ ==L ' SlGN:'4>Hai^ SIGN: SIGN:
PRINT: VcTl<?lAo PRINT; PRINT; PRINT;
firm: FIRM; vhV FIRM: FIRM:
DATE;,,..2-0-ci™E: pate- 1,1^10, TIME: IpO DATE: TIME: DATE; TIME:
II. RELINQUISHED BY: 11. 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:
111. 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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