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Chain of custody form, Westchester County Labs

Machine-extracted title · confidence 90%

Document tracking the transfer and custody of samples received by Westchester County Department of Labs & Research.

NYC-WTC_000071956–000071958

Folder label: “26393

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Scanned page image, NYC-WTC_000071956
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OCR status: ok · source: pdftotext

z z o WESTCHES-j^COUNTY DEPARTMENT CHAIN OF CUSTODY •cord o

I io OF LABS & RESEARCH A)yc 26^3- 263?/ LABORATORY WESTCHESTER COUNTY PAGE

o SDG# "0 C o NAME ADDRESS VALHALLA, NEW YORK CT o o CONTACT CONTACT _________________________ o' "0 co SAMPLING ANALYSES o cn CJ> LABORATORY SAMPLE PEST/ PRESER­ COMMENTS 9L SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC J O o "^7 o c 3 lo/s^oi CD 3

I. SAMPLED AND RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV, RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS. SIGN: n SIGN: SIGN: SIGN: PRINT: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE: IO.2S-O1TIME: DATE: TIME: DATE: TIME: DATE: TIME:

II. RELINQUI: BY: II. RECEIVED^: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: SIGN: ( ‘-Va. SIGN:<=^6^— SIGN: SIGN: PRINT: PRINT: PRINT: FIRM: 4.^ FIRM: FIRM: time: (^->7 DAT&z^^^TIME/^--^; DATE: TIME: DATE: TIME:

111. RELINQUISHED By:. ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: l<l^» (TIMEte-.V5 DATE: TIME: DATE: TIME:

EVIDENCE SAMPLES TAMPERED WITH:____ NO YES N/A SAMPLES DISPOSED OF ON: i

IF YES EXPLAIN IN REMARKS BY:

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NYC-WTC_000071956Source: NYC Law Department, mirrored locally

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