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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_000071992–000071999

Folder label: “26470

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Scanned page image, NYC-WTC_000071992
OCR text

OCR status: ok · source: pdftotext

z s WESTCHt OUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTODY ORD PAGE OF CD

'2 o o SDG# NAME _____________ ____________ LABOFUKTORY ADDRESS WESTCHESTER COUNPf VALHALLA, NEW YORK “0 c CT o' o CONTACT CONTACT "0 SAMPLING ANALYSES o co CD LABORATORY SAMPLE PEST/ # OF PRESER­ COMMENTS 03 KJ SAMPLEd SAMPLE NO. TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) O o Ol.Lp-C ~3~ 4= o c Tak /1)7 3 23^ ii “V 1 K. (5 CD 3

/ 7_ I. SAMPb I. RI .1' ANALYSES/COMMENTS; IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS; SIGN: IGI SIGN: SIGN: PRINT; 1 TLo) to PINT: PRINT: PRINT; FIRM: IV; FIRM: .4 FIRM: FIRM: 1^-^- 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_000071992Source: NYC Law Department, mirrored locally

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NYC-WTC_000070606 · Box DEP Box 61

Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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