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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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OF LABS & RESEARCH
PAGE I OfI
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NAME a;(J
LABORATORY
ADDRESS
WESTCHESTER COUNTY
VALHALLA, NEW YORK
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CONTACT CONTACT _________________________ ■D
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SAMPLING ANALYSES 3.
ro LABORATORY SAMPLE PEST/ PRESER 9L
COMMENTS
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC )
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2-<4^50 0902-
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7037
3 / 5- 3 < . T iOI<S
y/0 50 V iOO^' ■
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! I. SAMPLED ^'RELINQ. BY ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
s SIGN^sS--^ SIGN: SIGN:
5 PRINT: V. U<SLAO PRINT: PRINT:
FIRM: FIRM: FIRM:
DATE: fo/ifo/o/TIME:>^^c) DATE: TIME: DATE: TIME:
II. 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:
i
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 EXPLAI EMARKS BY:
11
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