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Chain of custody form, Westchester County Dept of Labs

Machine-extracted title · confidence 85%

Form tracking samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000071632–000071635

Folder label: “26078

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Scanned page image, NYC-WTC_000071632
OCR text

OCR status: ok · source: pdftotext

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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD CD

i PAGE OF OF LABS & RESEARCH

o o o o 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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NYC-WTC_000071632Source: NYC Law Department, mirrored locally

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NYC-WTC_000070981 · Box DEP Box 61

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

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