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Chain of custody form, NYC DEP sample AE04941, Mar 2002

Machine-extracted title · confidence 95%

Documentation recording the transfer and handling of a water sample submitted to Westchester County Department of Labs.

NYC-WTC_000074597–000074605

Folder label: “AE 04941

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Scanned page image, NYC-WTC_000074597
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OCR status: ok · source: pdftotext

-< Z WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE 1 OF[ O OF LABS & RESEARCH co o 5o SDG# NAME LABORATORY ADDRESS WESTCHESTER COL !ISS VALHALLA. I3055 YORK -D c CT I o o CONTACT CONTACT o' o '0 o SAMPLING ANzkLYSES O LABORATORY P. SAMPLE FEST/ #OF PRESER- COMMENTS OS Oi CD SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS. ETC) O o o c 3 o 3

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I. SAMI INQ. BY I. RECEIVED BY; ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS; SIGNt SIGNr-es^y^Z SIGN: SIGN; PRINT: PRINT; FIRM:J> VBLC-' cap? I FIRM: FIRM; FIRM: DATE: I [olTIME- DATE;, 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: in. 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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NYC-WTC_000074597Source: NYC Law Department, mirrored locally

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NYC-WTC_000074267 · Box DEP Box 62

Documentation tracking the custody and transfer of environmental samples to the Westchester County Department of Labs and Research.

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