Chain of custody record, Westchester County Department of Labs

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WESTCHE^Bj COUNTY DEPARTMENT CHAIN OF CUSTOl ORD o to * o^i^bsI^R^rch PAGE OF J 1 “0 so®*' > LABORATORY WESTCHESTER COUNTY C

■r o o o name* CONTACT . "****** yioZvTt wO—— _ . - ADDRESS CONTACT VALHALLA, NEW YORK ________ ________________ CT o' “0 o SAMPLING ANALYSES ro LABORATORY SAMPLE PEST/ #oF PRESER- COMMENTS SAMPLE NO, SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION O Ca3 oo (SPECIAL INSTRUCTIONS. CAUTIONS. ETC.) o o toJ'So )o I 1154 /« c 3 Q •2.66^ 7 JI 3

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L SAM^EDiANttRELlNQ. BY I. RECEIVED BY; ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS; SIGN: Z, kJ I SIGNP’-e---- / SIGN: SIGN: I, ■ PRINT; PRINT: PRINT; PRINT; ■ FIRM:.t^V<^-D&p FIRM: 6^ FIRM: FIRM; 1 PATE:, ♦1^0, TIME:|3^fl DATE:/o4^., DATE: TIME; DATE; TIME; li; 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; 111. RECEIVED BY; ANALYSES/COMMENTS; VI. RELINQUISHED BY; VI. RECEIVED BY; ANALYSES/COMMENTS; ! . SIGN: ‘ SIGN; SIGN; SIGN: i PRINT:' PRINT; PRINT; PRINT; « FIRM: FIRM; FIRM: FIRM: , . DATE; TIME; DATE: TIME; DATE: TIME; DATE: TIME; i! J „ a ! EVIDENCE.SAMPLES TAMPERED WITH; NO YES N/A SAMPLES DISPOSED OF ON;

ifjYes-explain in remarks BY: