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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_000072580–000072583

Folder label: “25663

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Scanned page image, NYC-WTC_000072580
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Z 1^ CHAIN OF CUSTODY RECORD ■<

o WESTCHESTER COUNTY DEPARTMENT o PAGE OF co OF LABS & RESEARCH g SDG# LABORATORY WESTCHESTER COUNTY ■D c o NAME ADDRESS VALHALLA, NEW YORK CT o o CONTACT bK <S-S____________ CONTACT _________________________ o' o ■D bO SAMPLING ANALYSES o cn 3. oo LABORATORY SAMPLE PEST/ #OF PRESER­ COMMENTS 91 o SAMPLE NO. SAMPLE NO. DATE . TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC) O o / o c 3 n 0^ ^6 I i, ' CD

EShE 7 ( a 7 pl ' rgjjicx c^^<L

I. SAMPLED AND RELINQ, BY I, RECEIVED/dY; ) 7. ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN; SIGN; SIGN: PRINT;p.vO. PRINT; PRINT: FIRM: - <0 FIRM:^^^t . FIRM: FIRM: 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:

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^REMARKS BY:

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NYC-WTC_000072580Source: NYC Law Department, mirrored locally

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