Chain of custody record, Westchester County Labs

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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o ID OF LABS & RESEARCH PAGE OF § '2 o o SDG# NAME C— LABORATORY WESTCHESTER COUNTY ADDRESS VALHALLA, NEW YORK ■D c CT o' o CONTACT fZkrrl5 CONTACT _________________________ ■D O SAM PUNG ANALYSES 3. 03 o LABORATORY SAMPLE PEST/ #OF PRESER­ CD COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC.) o o nkjoi ”7^77 77 ~77” >1 o c 3 CD vekii hlr)oi ZI i?.

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I. SAM^^ BY I. RECEIVEp ANALYSES/COMMENTS:

PRINT: SIGN; 5' IV. RELINQUISHED. BY: SIGN: PRINT: IV. RECEIVED BY; SIGN: PRINT: ANALYSES/COMMENTS:

FIRM:r^YC,D'S=f FIRM: FIRM; FIRM; DATE:„|<)o, TIME:|^^;^ 2!!^ 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:

IF YES EXPLAIN IN REMARKS BY: