Chain of Custody Record, Sample AE03934, Feb 2002

Z z o o WEST.CHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY'RECORD co

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'2 o o SDG# NAME LABORATORY WESTCHESTER COUNTY ADDRESS' VALHALLA. NEW YORK c CT o' o CONTACT CONTACT, _________________________ "0 o Ca5 CD SAMPLING ANALYSES 9L O> Ca3 LABORATORY SAMPLE PEST/ # OF PRESER­ COMMENTS O SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BN/k PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC ) o o I c 3 IK 5^ 57-^0) o 3

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I. SAMPLED AND RELINQ. W I. REipEIVED BY; ANALYSES/COMMENTS: । IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN; SIGN<-^//(/WflA/^^ i SIGN; SIGN; PRINT: PRINT: I PRINT: PRINT: FIRM; Ol^ FIRM; / FIRM; FIRM: DAJE-^f 7/ri- TIME://; DATE: 2,(((^/b7JIME: Ij'fO 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: 111. RELINQUISHED BY: 111. RECEIVED BY: ANALYSES/COMMENTS: VI. RELINQUISHED BY: VI. RECEIVED BY: ANALYSES/COMMENTS: SIGN: SIGN: SIGN; SIGN: PRINT; PRINT; 11 PRINT; PRINT: FIRM: FIRM: FIRM: FIRM: DATE. TIME: DATE: TIME; DATE; TIME; DATE: TIME:

EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A 1 SAMPLES DISPOSED OF ON;

IF YES EXPUklN IN REMARKS BY:

1