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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD co
PAGE OF
OF LABS & RESEARCH
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NAME
LABORATORY WESTCHESTER COUNTY
ADDRESS VALHALLA, NEW YORK
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CONTACT ^5?^ f^uT/,S CONTACT ____ ____________________
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yi SAMPLING ANALYSES
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LABORATORY SAMPLE PEST/ #OF PRESER COMMENTS io
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.) :o
/ > 6 /O
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I. (9 |o| 0^00 /
12
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I. SAMPLED ANDaRELINQ. BY I ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: ! SIGN: SIGN:
PRINT: UvU, IPRINT:/A- ranaro PRINT: PRINT:
FIRM: j52.< IFIRM:VjiyA-Co.-(Vr + FIRM: FIRM:
DATE:h/-7<o/ TIME;^^!DATE: ll-T-o\ TIME: I’.3^. 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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