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WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
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OF LABS & RESEARCH
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NAME
_____________ LABORATORY WESTCHESTER COUNTY
ADDRESS VALHALLA, NEW YORK
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SAMPLING ANALYSES
co. LABORATORY SAMPLE PEST/ #OF PRESER COMMENTS
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SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC ) O
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l.>8AUH£0^ RELINQ. BY I. RECEIVED BY: ,■ ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS:
SIGN: SlGNC/^Ud I'W'i— SIGN: SIGN:
PRINT^.tO, PRINT: PRINT:
FIRM: FIRM: in. FIRM: FIRM:
DATE: 'if TIME:)^^6 pate: TIME: 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:
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