Westchester County Lab chain of custody form

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o SDG# LABORATORY WESTCHESTER COUNTY o' o AJ ADDRESS VALHALLA,JSEVVYO^_ "0 o o o / Ca5 I ^S!3?act CONTACT _________________________ 3. CD

OO ‘SAMPITR'S’ OTATVSES' O o Ca5 LABORATORY SAMPLE ■pEsTT #OF PRESER- comments o c SAMPLE NO, SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) 3 CD Z5 R ^2325- 7 I Ui. S'2^

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I SAMPLED AND RELINQ. BY i. RECEIVI ANALYSES/COMMENTS; IV. RELINQUISHED. 0Y: IV. RECEIVED BY: ANALYSES/COMMENTS. sJGfe>r "73^- SIGN;( SIGN; SIGN: PRINT:^_ • , X PRINT: PRINT: FIRM; FIRM: FIRM: FIRM: DATE:.50^ TIME//.-/;: DATE: TIME: DATE: TIME: H, RECE Wd BY: II. RELINQUISHED 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:

HI 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: