WESTCHESTER COUNTY DEPARTMENT
GF LABS & RESEARCH _
CHAIN OF CUSTODY RECORD PAGE 1 OF 2 J
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SDG# ■ LABORATORY WESTCHESTER COUNTY ■ “0
NAME ADDRESS VALHALLA, NEW YORK " c
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CONTACT CONTACT _ __________________________ o'
SAMPLING -
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ANALYSES
LABORATORY SAMPLE a.
PEST/ #0F PRESER-' ■ - COMMENTS 9L
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1. SAMPLED ANDjRELINQ. BY 1. RECEIVED BY: ANALYSES/COMMENTS: IV- RELINQUISHED. BY: IV. RECEIVED BY: ■ ANALYSES/COMMENTS:
SIGNt"^^^ i r SIGN;- SIGN:
PRINT; PRINT; PRINT;
FIRM: 4> fcC' __ FIRM;, FIRM; FIRM;
DATE^^Io’^- TIME:H;\S DATE: 'x>:TIME:9;^' 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:
■ TIME:" ' T TIME: .
DATE; TIME: DATE; .TIME; DATE; DATE;
EVIDENCE SAMPLES TAMPERED WITH: NO..YES N/A SAMPLES DISPOSED OF ON:
IF YES EXPLAIN IN REMARKS ' ’ " BY:
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