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

z z ■< ■< ' •» o CHAIN OF CUSTODY RECORD o io WESTCHESTER COUNTY DEPARTMENT OF LABS & RESEARCH PAGE OF co

■D I SDG# LABORATORY WESTCHESTER COUNTY c o CT o ADDRESS VALHALLA, NEW YORK o NAME o' o CONTACT ____________________________ CONTACT ■D o O KJ SAMPLING ANALYSES 3. cn QJ KJ LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC ) o o >1 ■ ^qI' I |< o -4. I0 c 3 CD 0^ 0& ESHT 4: I 4

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I. RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN:"?.^ SlGhU-^i— SIGN; SIGN: PRINT: PRINT: PRINT; PRINT: FIRM: FIRM: G+y2- FIRM; FIRM: DATE;<x/.(o> TIME:p3^ DATE;///03 TIMEyj;y- 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;