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§ OF LABS & RESEARCH
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NAME
LABORATORY WESTCHESTER COUNTY
ADDRESS VALHALLA. NEW YORK
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CONTACT CONTACT _________________________
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SAMPLING ANALYSES
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SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC ) O
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RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY; ANALYSES/COM M ENTS:
SIGN: f’lJ, SIGN: I SIGN; SIGN:
PRINT: b vJ> PRINT; PRINT: PRINT:
FIRM:P‘<c,b^f FIRM; FIRM: FIRM:
DAT&2(Ho2xTlh^^ DATE: DATE: TIME: DATE: TIME:
11. 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:
HI. RELINQUISHED BY: HI. 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:
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