I WESTCHESTER COUNTY DEPARTMENT z
z CHAIN OF CUSTODY RECORD -<
o
- OFTaBS & RESEARCH' PAGE_J_ OF.I
o <D
s ■t ~ -
SDG#
NAME
~ LABORATORY
■ ADDRESS "
WESTCHESTER COUNTY "
VALHALLA, NEW YORK
“0
c
'2
o
o
CONTACf CONTACT __ ___________ ______________ o'
o - SAMPLING ANALYSES "□
o
LABORATORY’ SAMPLE PEST/ TOF PRESER
o
' SAMPLE NO. SAMPLE NO.
COMMENTS 9L
tn DATE TIME TYPE VOA BNA PCB’^". METALS CN - BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC |
co
O
o
a .526’3 ■■2^ /o/oz. o
c
3
CD
5"*^ ij lv/02. 0^ -22-
F&C>
. „ 1. SAMPLED AND RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN:-'-®’— SIGN: SIGN:-
- PRINT: PRINT: PRINT: PRINT:
FIRM: EP Q nr
FIRM: FIRM: FIRM:
' DATE:2//p /o 2^.TIME^-3^>» DATE: 2//o/o2JIME:<?>35- DATE: TIME: DATE: TIME:
’ ; II. RELINQUISHED BY:' II. RECEIVED BY:. ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY:' . ANALYSES/COMMENTS:
SIGN: - SIGN: 0 ' SIGN: SIGN:
PRINT: PRINT: PRINT: PRINT:
, FIRM: FIRM:
.a 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: 4 ■
- EVIDENCE SAMPLES TAMPERED WITH:— NO - YES---- N/A SAMPLES DISPOSED OF ON:
-i
IF YES EXPLAIN IN REMARKS BY:
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000073597Source: NYC Law Department, mirrored locally