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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD CD
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PAGE OF
OF LABS & RESEARCH
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SDG#
NAME
CONTACT
LABORATORY WESTCHESTER COUNTY
ADDRESS
CONTACT
VALHALLA. NEW YORK
_________________________
I
CD SAMPLING ANALYSES
O LABORATORY SAMPLE PEST/ #OF FREsEk- COMMENTS
KJ
1
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC.)
ZSZEUZ O^nl 7 14-
7 IL
I 0.4-< PdjxMe 7 10
I. SAMPLED RELINQ. BY I. RECaVED BY: , ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS:
SIGN: AW. SIGN: SIGN:
PRINT: h,vJ. PRINT: PRINT: PRINT:
FIRM; FIRM: FIRM:
DATEjo/^5/o^lM&J^ ’PATE:|o/^2^ojTIME:|4a?5 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;
Ui. 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 EXPLA^^ REMARKS BY:
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