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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_000072443–000072450

Folder label: “25457

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Scanned page image, NYC-WTC_000072443
OCR text

OCR status: ok · source: pdftotext

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5'. o’ WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE / OF / o CD

s: OF LABS & RESEARCH “0 o SDG# LABORATORY WESTCHESTER COUNTY c I CT o NAME ADDRESS VALHALLA. NEW YORK o o' o CONTACT CONTACT _________________________ : o "0 o ro sampling ANALYSES UXBORATORY SAMPLE pEST/ #OF PRESER- COMMENTS 9L Ca5 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) O o o c 673 3 CD 3

iohl- 9138 lOh la

f/Zl •7.6M k,0 3-gzso i 9735D 2532322 b?,si 1 yoosp 5 l( 1. SAMPLED AND RELINQ. BY I. RECEIVED BY: ' ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: 1 SIGNS^ SIGN: SIGN; PRINT; V, hStAZ> , PRINT: Ic.tonVSo/l PRINT; PRINT; 1 FIRM: UFIRM: I '* FIRM: FIRM: DATE: (O-iT-oITIME: ; DATE:(o/r?(otTIME:\ll6 DATE: TIME: DATE: TIME:

II. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN; SIGN; r 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: jl EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:

IF YES EXPL^^N REMARKS BY:

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NYC-WTC_000072443Source: NYC Law Department, mirrored locally

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NYC-WTC_000070652 · Box DEP Box 61

Record documenting the chain of custody for samples submitted to the Westchester County Department of Labs and Research.

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