Chain of custody record, Westchester County Department of Labs

z z WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o o OF LABS & RESEARCH page L of t co

SDG# LABORATORY WESTCHESTER COUNTY “0

■2o C NAME ADDRESS VALHALLA, NEW YORK CT

CONTACT Li___________________ o' o CONTACT o "0 ANALYSES ’ o Ca3 SAMPLING CO LABORATORY SAMPLE PEST/ #OF PRESER- comments 03 CD SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) O o o c 3 0 3 1 I o 3 5:^

EES

1. SAh AND RELINQ. BY I. RECEIVEDBYl . ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: I SIGN: SIGN: PRINTS3". PRINT; PRINT; PRINT: FIRM: OeP FIRM:6f/^ FIRM: FIRM: DATE->\i.-;\o-^1ME‘T',‘^o DATE;2^/^/6)2.T1ME: DATE: TIME: DATE: TIME: I II. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMENTS: 1 SIGN; SIGN: SIGN; SIGN: PRINT; PRINT; PRINT: PRINT: FIRM. FIRM: FIRM: FIRM; DATE: TIME: DATE; TIME: DATE: TIME: DATE: TIME: 111. RELINQUISHED BY: 111. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: I SIGN: SIGN: SIGN: SIGN: i PRINT; PRINT; PRINT: PRINT; F1RM:_ FIRM: FIRM: 'i 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;