Chain of Custody Record, Sample AE03471, Feb 2002

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o o io WESTCHESTER COUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTODY RECORD PAGE i OF t co

I LABORATORY WESTCHESTER COUNTY “0 o SDG# c o CT o ADDRESS VALHALLA, NEW YORK o NAME o' CONTACT CONTACT ____________________________ "0 GO o O SAMPLING ANALYSES 00 9L LABORATORY SAMPLE PEST/ #OF PRESER- COMMENTS TYPE SNA PCB METALS CN BOTTLES O SAMPLE NO. SAMPLE NO. DATE TIME VOA VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC } o o c 3. 2J(3 .^7/ 3 CD

SB ^72^

2^37-S~Q 17^ 102. 7m ^7^ 3£y>5r> 2^ 12.1 0'2. 0‘^er^

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I. SAMP^^ AND RELINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS; IV. RELINQUISHED. BY; IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN_z2v—71 / SIGN: SIGN: S T: p n PRINT PRINT: PRINT: FIRM: -S5CV’ "IRM: FIRM: FIRM: DATE: -J^c,3\oyTIME: D 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;