Chain of custody record, Westchester County Department of Labs &

z z WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD PAGE i OF/ o o io OF LABS & RESEARCH SDG# i LAI3ORATORY WESTCHESTER COUNTY co

■D I NAME kJ u cNvf* ADDRESS VALHALLA. NEW YORK c o CT o CONTACT I_________________ o CONTACT o' o ■D SAMPLING ANALYSES O o LABORATORY SAMPLE Fest/ I #OF PRESER- comments 3. CD 03 cn SAMPLE NO. SAMPLE NO. DATE TIME TYPE VO/\ BNA PCB METALS -CN . BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS, ETC ) I o o o 3. 75773 c I 3 CD 3/ 7- /(i3~ u O I / Z23 iw ] •2. <^•3 S'O tT-5l 3/ Io2 ofLl I. I ^T-bP i0l5~ ^777 K I i/?,‘?S'O jTW ^2^ k I IbOP 5L7J

I I. SAMPLED AND RELINi^BY I. RECEIVED BY: ANALYSES/COMMENTS; IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGN;-^(^. SIGN; SIGN: PRINT^' ' i PRINT: PRINT; PRINT: FIRM: I ^TIME:f DATE: FIRM: FIRM: DATE; 1 DATE: TIME: DATE: TIME:

II. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMh^ENTS: 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;