Chain of Custody Record, Westchester County Dept of Labs

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s WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o co PAGE OF OF LABS & RESEARCH

'2 o o SDG# ___________ ______________ ,____ _ _______________ LABORATORY ADDRESS WESTCHESTER COUNTY VALHALLA, NEW YORK ■D C CT

o NAME o' Ca5 CONTACT J, kL /^ < CONTACT ____________________________ ■D O Ca3 3. O> sampling ANALYSES 03 LABORATORY SAMPLE PEST/ # OF PRESER­ COMMENTS o SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC) o o c 2-7/2- 3. -i -62, S" / 3 CD O

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F&iA) 2-7/^ </~7 / A' •73 0 I

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I. sAMFteeo I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: e— ,-O) AxT/ f SIGN: SIGN: PRINT: A PRINT: e . PRINT: PRINT: FIRM: FIRM: FIRM: DATE;j2./<//p2_ 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;