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Chain of custody form, Westchester County Labs

Machine-extracted title · confidence 50%

Record documenting the transfer and chain of custody for samples sent to the Westchester County Department of Labs.

NYC-WTC_000071466–000071468

Folder label: “27232

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Scanned page image, NYC-WTC_000071466
OCR text

OCR status: ok · source: pdftotext

z o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD •I i OF LABS & RESEARCH PAGE OF •J <0

i “0 o SDG# LABORATORY WESTCHESTER COUNTY c o : Z o o NAME ADDRESS VALHALLA. NEW YORK ■ o' CONTACT 7 CONTACT , "0 o CD SAMPLING ANALYSES CD LABORATORY SAMPLE 9L PEST/ PRESER- COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN VATION O (SPECIAL INSTRUCTIONS. CAUTIONS, ETC) o o c /9^ 3 CD 3 22^5 // -ai

I. SAMPLED RELINQ. BY I. RECEIVED BY: , ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COM M ENTS: SIGN:-=^ SIGN.<XZ4X7L>jUt<<5T-^ SIGN: SIGN: PRINT; V. TifeCAO PRINT: PRINT: PRINT: FIRM: FlRM:m.^ FIRM: FIRM: DATE: TIME: DATE:TIME:// 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:

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NYC-WTC_000071466Source: NYC Law Department, mirrored locally

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NYC-WTC_000071348 · Box DEP Box 61

Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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