Chain of custody record with contact details, Westchester County

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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o 5 OF LABS & RESEARCH PAGE( OF I co

i “0 SDG# LABORATORY WESTCHESTER COUNTY c CT NAME ADDRESS VALHALLA. NEW YORK o' CONTACT CONTACT '0 O SAW PUNG anAlySeS p. LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS 2 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) o o o c t--- 3 o 3- 1^

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I I. SAMPLED AND^LIh^BY I. RECEIVED BY; ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS: ! SIGN: <4; SIGN: fWltM SIGN: SIGN; li PRINT: PR’NT; PRINT; PRINT: FIRM; L^l Z , FIRM: FIRM: FIRM: DATE/ll/z/6} TIME: DATE; TIME; DATE: TIME;

I. 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:

g>IF YES EXPLAIN IN REMARKS BY:

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