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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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OF LABS & RESEARCH PAGE OF
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NAME
LABORATORY WESTCHESTER COUNTY
ADDRESS VALHALLA, NEW YORK
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o SAMPLING ANALYSES
CD LABORATORY SAMPLE PEST/ #OF PRESER 9L
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SAMPLE NO. SAMPLE NO. date. TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) O
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I. SAMPLED ANDjRELINQ. BY I. RECEIVI ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: Z SIGN: SIGN: SIGN;
PRINT: PRINT; PRINT; PRINT;
FIRM; FIRM: FIRM: FIRM;
DATE; 11 /So) TIME^7.,a DATE: 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:
YES EXPLAIN IN REMARKS BY:
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