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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_000071974–000071976

Folder label: “26433

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Scanned page image, NYC-WTC_000071974
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OCR status: ok · source: pdftotext

z z o WESTCHES' 'COUNTY DEPARTMENT CHAIN OF CUSTODY ©CORD o PAGE OF co g. OF LABS & RESEARCH o I ■ SDG# LABORATORY WESTCHESTER COUNTY ■D o y c <=>► NAME ADDRESS VALHALLA. NEW YORK CT §1 CONTACT CONTACT o' "□ o SAMPLING ANALYSES LABORATORY SAMPLE PEST/ PRESER- COMMENTS 9L SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC) O o o c 3 o 777^ 3

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1. SAMPLED RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGNl,.-^ SIGN:MSMM' SIGN: SIGN: PRINT: U.TlfiLAO PRINT: P.UaA /I PRINT: PRINT: FIRM: e. FIRM: ■' FIRM: FIRM: DATE: 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_000071974Source: NYC Law Department, mirrored locally

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