Chain of custody record, Westchester County Lab

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o o io CD OF LABS & RESEARCH PAGE OF ■D 1 SDG# C/ LABORATORY WESTCHESTER COUNTY c CT o NAME h ADDRESS VALHALLA, NEW YORK o o' o o CONTACT ____ CONTACT _________________________ ■D O ro SAMPLING Analyses 3. KJ g) KJ LABORATORY SAMPLE PE^ #OF PRESER­ COMMENTS OJ TIME TYPE O SAMPLE NO. SAMPLE NO. DATE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC) o o c 3 CD

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l\ I. SAMP^gA^JD^U^^^ I. RECEIVJ ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS: SIGN; / SIGN; SIGN: PRINl'J&^A^-^y-^ PRINT: PRINT: PRINT: FlRM:V<i^ S f t o FIRM; FIRM; FIRM: Maf TiMB iXVt) DATE: TIME: DATE; TIME;

II. RELINQUISHED BYj^ /) - ^1. RECEIVED BY: ANALYSES/COMMENTS; V. RELINQUISHED BY; V. RECEIVED BY: ANALYSES/COM M ENTS; SlGNr^7iy^^55^3e»«*CT‘“^ ■SK3N: 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/COM M ENTS: 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: