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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD
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OF LABS & RESEARCH
SDG# - ____________ LABORATORY WESTCHESTER COUNTY
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OO SAMPCIRG ANALYSES o
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DATE TIME TYPE
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SAMPLE NO. SAMPLE NO. VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC)
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I. OAMPLED RELINQ. BY I. RECI iYj ANALYSES/COMMENTS; IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS;
SIGN; SIGN. SIGN: SIGN;
PRINT:>.u>.fev-^^- PRINT: PRINT;
FIRM.fJY'^'bFP FIRM; FIRM: FIRM:
DATE: |(^3 tf>Z, TIME:(»< DATE: TIME; DATE; TIME;
11. RELINQUISHED BY: 11. 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 EXPLAIN IN REMARKS BY:
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