Chain of Custody Record, Westchester County Dept of Labs

VVESTCHESTERCpUNTY DEPARTMENT,_ __ CHAIN OF CUSTODY RECOR^ I I,I PAGE I ’OF~~f ~ — - co OF LABS & RESEARCH LABORATORY WESTCHESTER COUNTY T SDG# < c CT NAME ADDRESS VALHALLA, NEW YORK LJ o' CONTACT CONTACT _________________________ "0 o SAMPLING ANALYSES p. OS UKBORATORY SAMPLE PEST/ #OF PRESER­ COMMENTS DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION a SAMPLE NO. SAMPLE NO. (SPECIAL 1NS5RUCllONS. CAUHONS. El C ) o o c 3 3 Q 3

16'/^ •3-3t/-S-O 7?^ 'HISS'D 0^57^ LLLSl

gP^-SO 12T7

I I. SAMPLED AND RELINQ. BY I. RECEJVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN; P siGhK..^(tUivjhAt5'— SIGN; SIGN: PRINT: PRINT;|z PRINT; PRINT; FIRM. firm: ‘vnu FIRM; FIRM: DATE.\$0yZy- TlME:/^5<i^ DATE: DATE; TIME: DATE; TIME:

11. RELINQUISHED BY; 11. 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;