Chain of Custody Record, Westchester County Dept of Labs

z ■<

Z o co CHAIN OF CUSTODY RECORD ■<

O WESTCHESTER COUNTY DEPARTMENT PAGE j OF t OF LABS & RESEARCH § TJ c '2 o o SDG# NAME kJ la cb»t-P LABORATORY ADDRESS WESTCHESTER COUNTY VALHALLA. NEW YORK CT o' no o o CONTACT CONTACT _________________________ p. Ca5 SAMPLING ANALYSES Ca5 00 LABORATORY SAMPLE PEST/ #OF PRESER­ COMMENTS O bO o SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC | o c 3 CD 3 102^ ^2-7^/ 3

2/6 I Q i. ■17^5

OW<3, x/V /ox {2-58o/i Z7^ |2- L 272V

e^2,qS.G </ lav ztFV' Cy2>92,‘6

9gp Ci2S^ 9'14-5

ESk ztFv

I. SAMt^D AND REl^Q.^ I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS. SIGNr-e— SIGN: SIGN; PRINT; PRINT: PRINT: PRINT; FIRM: FIRM: FIRM; FIRM; DATE;2/<f/ox 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: