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Chain of custody record, Westchester County Department of Labs &

Machine-extracted title · confidence 95%

Form documenting the chain of custody for samples submitted to or received from the Westchester County laboratory.

NYC-WTC_000075065–000075069

Folder label: “AE 05899

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Scanned page image, NYC-WTC_000075065
OCR text

OCR status: ok · source: pdftotext

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o o WESTCHESTER COUNTY DEPARTMENT CHAIN OF CUSTODY RECORD CD OF LABS & RESEARCH PAGE OF ■D SDG# LABORATORY WESTCHESTER COUNTY c o CT o NAME ADDRESS VALHALLA. NEW YORK o' o o CONTACT CONTACT "0 o cn SAM f’LlNG -YStS o o> LABORATORY SAMPLE PEST/ 9L cn #OF PRESER- COMMENTS SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS, CAUTIONS. ETC.) O o 4 I o Olis' c 3 I>gL-fi? 2Sj£^ 01^ ± 1 5 CD 3

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I. RECBV ;D BY; ANALYSES/COMMENTS; IV. RELINQUISHED, BY; IV. RECEIVED BY; ANALYSES/COMMENTS; SIGNS^ SIGN: SIGN: PRINT: PRINTX. PRINT: PRINT: FIRM;N-|c-be,F FIRM: FIRM: DATE:3|7lo2, TIMEjj^b DATE: TIME; DATE: TIME:

IL 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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NYC-WTC_000075065Source: NYC Law Department, mirrored locally

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NYC-WTC_000074387 · 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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