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WESTCHtorA:<;OUNTY DEPARTMENT CHAIN OF CUSTODY l<^ORD O
OF LABS & RESEAI,RCH PAGE OF i
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SDG# LABORATORY WESTCHESTER COUNTY ( "D
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NAME
CONTACT
ADDRESS
CONTACT
VALHALLA, NEW YORK
_________________________
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KJ SAMPLING ANALYSES . o
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LABORATORY SAMPLE PEST/
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SAMPLglO. SAMPLE NO. DATE TIME type , VOA Z BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC) O
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I. SAW ;d ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN; SIGN: SIGN:
PRINT: PRINT: PRINT:
FIRM: FIRM: FIRM;
TIME;^rt^ATE; 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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