Chain of custody record, Westchester County Labs

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WESTCH^^R COUNTY DEPARTMENT o o CHAIN OF CUSTOO ECORD co io OF LABS & RESEARCH PAGE OF ■D c 1 SDG# LABORATORY WESTCHESTER COUNTY £ CT o c-^ ZZ ADDRESS VALHALLA, NEW YORK o NAME o' o o CONTACT 71 . CONTACT _________________________ ■D o 3. "SOT PLING ANALYSES 03 CD LABORATORY SAMPLE PEST/ #OF PRESER­ SAMPLE NO. SAMPLE NO. date TIME VOA BNA PCB METALS CN BOTTLES COMMENTS o o VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC ) o ( /I c 3 MJSZZZ _J__ A JO.. CD h 1 A

7 I. SAlVMtEBA I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN:Z!(ti^ TTh^n(?v«c_c SIGN:<=aOt—/?/ SIGN: SIGN; PRINT PRINT: PRINT: FIRM: flJYC-/? FIRM; FIRM; DATE:/ DATE; TIME: DATE: TIME: II. RELIh/c/uiSHED 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;