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§ WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE J OF t
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o OF LABS & RESEARCH
o
o LABORATORY WESTCHESTER COUNTY
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SDG#
NAME
CONTACT
ADDRESS
CONTACT
VALHALLA, NEW YORK
____________________ I
GO
LABORATORY
SAMPLE NO. SAMPLE NO. DATE
SAMPLING
TIME
SAMPLE
TYPE VOA BNA
FeST/
PCB
ANALYSES
METALS CN BOTTLES
PRESER
VATION
COMMENTS
(SPECIAL INSTRUCTIONS, CAUTIONS, ETC)
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I, SAMPLELLAND RELINQ. BY I, RECEl ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN>^==^-^=3^---- , • SIGN; SIGN: SIGN;
PRINT: V' PRINT: PRINT: PRINT;
FIRM: FIRM: FIRM: FIRM;
i9/o,time: DATE; TIME; DATE: TIME;
II, RELINQUISHED BY: II. RECEl’ ;D 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 ^PLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON;
IF YES EXpWi IN REMARKS BY:
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