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o rj WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD o
PAGE OF
i OF LABS & RESEARCH
SDG# LABORATORY WESTCHESTER COUNTY
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o NAME ADDRESS VALHALLA. NEW YORK c
o CT
o CONTACT CONTACT _________________________
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SAMPLING ANALYSES ■D
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LABORATORY SAMPLE PEST/ #0F PRESER 3.
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COMMENTS 03
SAMPLE^^. SAMPLE NO. DAJE / TIME TYPE , VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC )
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Be 1
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3;:;- o
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337 -M— 3
CD
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517^
V
7 7
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>• SAI^ I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS:
SIGN; ( SIGN;—7j r SIGN: SIGN:
PRINT; '^pPRINT; PRINT: PRINT:
FIRM: FIRM: FIRM: FIRM:
DATE; r pate;^^me-3,^s- DATE: TIME: DATE: TIME:
II. RELlMQUteHED 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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