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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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OF LABS & RESEARCH PAGE J OF J.
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SDG# LABORATORY WESTCHESTER COUNTY C
o ADDRESS VALHALLA. NEW YORK CT
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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 )
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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:
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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
Document recording the chain of custody for samples submitted to the Westchester County Department of Labs and Research including sampling contact information.
9 shared non-person entities · 1 shared topics · Same agency, volume and box · similarity 0.993