Chain of custody record, Westchester County Labs, Oct 2001

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“0 SDG# ________ LABORATORY WESTCHESTER COUNTY c § NAME :w3ZS]ZZZZZZZZZZZT ADDRESS VALHALLA, NEW YORK CT o' CONTACT rWlTTr CONTACT "0 § SAMPLING ANALYSED o

I LABORATORY SAMPLE NO. SAMPLE NO. DATE TIME SAMPLE TYPE VOA BNA PEST/ PCB METALS cn: PRESER­ BOTTLES- VATION iCOMMBnTS {SPECIAL INSTRUCTIONS, CAUTIONS. ETC ) 9L O o II - ~7~~~ H o c ■■ 5 ■I Wil Z H B CD 3

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I. RECEIVEmaY^ hv I. SAMPI ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COMMENTS; SIGN: SIGN; SIGN;

I- Wii® FIRM: 1 PRINT: FIRM; DATE; n>/xt./o{ TIME; 1560 DATE;|^ PRINT; FIRM: DATE; TIME: PRINT: FIRM; DATE: TIME:

II. RELINQUISHED BY; 11. RECEIVED BY; ANALYSES/COMMENTS; V. RELINQUISHED BY: V. RECEIVED BY;- ANALYSES/COMMENTS: SIGN: SIGN; $IGN: SIGN:

■ PRINT: FIRM: CATE: TIME: PRINT: FIRM; DATE; TIME: PRINT: FIRM: DATE: TIME: PRINT; FIRM: DATE: TIME:

I UI. RELINQUISHED BY:^ III. RECEIVED BY; ANALYSES/COMMENTS: Vt. 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:

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