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Chain of custody form, Westchester County Labs

Machine-extracted title · confidence 90%

Chain of custody record for samples submitted to the Westchester County Department of Labs and Research.

NYC-WTC_000072362–000072369

Folder label: “25259

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Scanned page image, NYC-WTC_000072362
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z -< o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o co OF LABS & RESEARCH PAGE I OfI

'2 o o SDG# NAME a;(J LABORATORY ADDRESS WESTCHESTER COUNTY VALHALLA, NEW YORK ■D C CT

o o' CONTACT CONTACT _________________________ ■D KJ o Ca3 O> 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 ) O o o c id/Ha 3 CD

I US'D ID fllT nos 2-<4^50 0902- xL 1 7037 3 / 5- 3 < . T iOI<S

y/0 50 V iOO^' ■

I ! 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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NYC-WTC_000072362Source: NYC Law Department, mirrored locally

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NYC-WTC_000071265 · 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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