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o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD co
OF LABS & RESEARCH PAGE OF
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SDG# LABORATORY WESTCHESTER COUNTY c
CT
o NAME ADDRESS VALHALLA, NEW YORK o'
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o CONTACT CONTACT _________________________ ■D
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o SAMPLING ANALYSES 3.
03
cn LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS
SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC.)
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CA-TLGfV^' “SIS 41 I 4- c
3
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I. RELINQ. BY I. REGfElyEI ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: Z IaJ SIGti SIGN; SIGN;
PRINT:ti^,vJ. -- PRINT PRINT: PRINT:
FIRM:ti4c-^^P FIRM: FIRM; FIRM:
DATE.-! Zy(o^TIME:\^^5 DATE;, fS.j, 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;
111. RELINQUISHED BY: 111. 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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