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Document / 3 pages

Chain of custody record, Westchester County Department of Labs

Machine-extracted title · confidence 95%

Form documenting the transfer and logging of environmental samples at the Westchester County laboratory.

NYC-WTC_000072249–000072251

Folder label: “25044

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Scanned page image, NYC-WTC_000072249
OCR text

OCR status: ok · source: pdftotext

z z WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o o co OF LABS & RESEARCH PAGE J OF J. “0 SDG# LABORATORY WESTCHESTER COUNTY C o ADDRESS VALHALLA. NEW YORK CT o NAME o o' o CONTACT CONTACT "0 ro o KJ SAMPLING ANALYSES LABORATORY SAMPLE PEST/ #OF PRESER­ 9L o COMMENTS SAMPLE NO. SAMPLE NO.- DATE TIME TYPE VOA BNA PCB METALS CN 'BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) O o o c 3 CD 3 |gf lA’Io c\.cr7au,

1. 'LEDAND RELINQ. BY I. RECEIVED BY: -/ , ,ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN:>e> S1GN;//}/U(/«6W SIGN: SIGN: PRINTS. PRINT:^_CAnZ^ PRINT: PRINT: FIRM: FIRM:/;)^^ FIRM: FIRM: DATE:ralvaAcX TIMEfO AS DATE: /O//4/6/ ’ DATE: TIME: DATE: TIME:

11. RELINJ BY: 11. REQET D by- ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: S1GN(2 SIGN:-^ SIGN: SIGN: PRINT: PRINT: PRINT: PRINT: FIRM. FIRM; FIRM; FIRM: DATE:. TIME:-- DATE; TIME: DATE: TIME: DATE: TIME: ntiBSi 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 EXPLAir^y EMARKS BY:

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NYC-WTC_000072249Source: NYC Law Department, mirrored locally

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NYC-WTC_000071348 · Box DEP Box 61

Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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