Chain of custody record, Westchester County Department of Labs

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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o o PAGE OF co OF LABS & RESEARCH g SDG# LABORATORY WESTCHESTER COUNTY ■D C o NAME ADDRESS VALHALLA, NEW YORK CT o o CONTACT CONTACT _________________________ o' o ■D ro Ca5 ■ SAMPLING aimLYSES O 3. LABORATORY SAMPLE PEST/ PRESER- COMMENTS 03 Ca5 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC ) o o o /o//sfot Tono An c 3 CD /o'2S

T I. SAMPLED ELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN; SIGN>X^QV^!4htU.i SIGN; SIGN; PRINT; V / TI^LA-> PRIN^ PRINT: PRINT: FIRM: (?. E-r FIRM: FIRM: FIRM; DATE: (jrjo (TIME: 11'.;^ DATE: to/,5fttime: |/& DATE: TIME: DATE: TIME:

11. 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 EXPLA^^ REMARKS BY;