Chain of custody record, Westchester County Dept of Labs, Jan

Z ! JA/ESTOHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o to OF LABS & RESEARCH ______________________________________________ PAGE i OF[ 91

I o' o 5! SDG# NAME CONTACT sampling LABORATORY ADDRESS CONTACT WESTCHESTER COUNTY VALHALLA, NEW YORK

ANALYSES -0 c CT o' T) o p. o LABORATORY SAMPLE 9L KJ TEST? »OF PRESER- COMMENTS O O 00 SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) o o I c 3 7-6 In I 3 o 3

1'2.5'SID Too^ 7^‘^'4-5'D t/ 3/102.

113/ [02. 52^ 2 s Up I /'SI /q-j^ (f^ •iD^SQ. I / S I /03. 10(0 2* f

I. SAMPLED/ND RELINQ. BY I. RECEIVED BY; ANALYSES/COMMENTS; IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS SIGN; SIGr4/ZtWL<-^ SIGN; SIGN: PRINT:<r///\y PRINT-g.M/S!grt(/5^ PRINT;/. ’^ PRINT; PRINT: P’RM: , , F'RM; IXTLr ,3 FIRM: FIRM: DATE^^/y/;^ TIME// DATE: , /o2 TIME;) 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 EXPLAIN IN REMARKS BY;