Chain of Custody Record, Westchester County Lab, Mar 2002

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s Z WESTCHESTER COUNTY DEPARTMENT OF LABS & RESEARCH CHAIN OF CUSTODY RECORD PAGE I OF H o co

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'2oo SDG# NAME _______ r— LABORATORY WESTCHESTER COUNTY ADDRESS VALHALLA, NEW YORK c CT o' o CONTACT ______________ CONTACT ______________________ "□ o SAMPLING ANALYSES 9L 00 o> LABORATORY SAMPLE PEST/ O SAMPLE NO. SAMPLE NO. # PRESER- COMMENTS o DATE TIME TYPE VOA SNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTIONS, ETC) o c 3 o 3 IZ sL^ 3^^ oi)blL. rt oib 2>O ifT f b55o iZ L5" •3i~ Trn 33- snK 3

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IPLED AND RELINQ. B' I. SAMPLED BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY; IV. RECEIVED BY; ANALYSES/COMMENTS: SIGN: SIGN: SIGN: PRINT; PRINT: PRINT: FIRM: ^/^ME:/'^'DATE^^TIME:fe5 ^/^ME:/'^ FIRM: FIRM; 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:

111. 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;