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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_000072684–000072686

Folder label: “25830

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Scanned page image, NYC-WTC_000072684
OCR text

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z o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD I i OF LABS & RESEARCH LABORATORY WESTCHESTER COUNTY PAGE OF co

o SDG# ■D c o. NAME ADDRESS VALHALLA, NEW YORK CT Oi OI CONTACT _________________________ o' CONTACT rof "0 SAMPONG ANALYSES o co- 4^ LABORATORY SAMPLE PEST/ PRESER­ COMMENTS 9L SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC ) O o o c 3 I I 1 I o 3

hI. r I

I I. SAMg^^pAN^RELINQ. BY I. RECEIVED BY. ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS; SIGN: SIGN: SIGN; PRINT; naort PRINT: PRINT: FIRM: 1>£P FIRM; C .r FIRM: FIRM; DATE: 10/2.11 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 EXP♦ N REMARKS BY:

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NYC-WTC_000072684Source: NYC Law Department, mirrored locally

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