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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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s OF LABS & RESEARCH PAGE OF
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o SDG# LABORATORY WESTCHESTER COUNTY “0
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o NAME ADDRESS VALHALLA, NEW YORK CT
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o CONTACT CONTACT _________________________ "0
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o SAM PLING ANALYSES
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LABORATORY SAMPLE PEST/ #OF PRESER COMMENTS
SAMPLE Ng SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION o
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(SPECIAL INSTRUCTIONS, CAUTIONS, ETC.) o
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I- RECet Bky ANALYSES/COMMENTS; IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN;t:^ SIGN: SIGN:
PRINT; V.uO. PRINT; print; PRINT:
FIRM: FIRM: FIRM; FIRM:
DATE:„lrjol TIME;, 7-^0 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:
HI. RELINQUISHED BY; 111. 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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