Chain of custody record, Westchester County Department of Labs &

-< z o o WesTcFiester county department CHAIN OF CUSTODY RECORD PAGE 1 OF 1 co OF LABS & RESEARCH g “0 SDG# y LABORATORY WESTQHEJTgRC c CT o NAME ARDRESS VALHALLA. NEW YORK o o' o CONTACT CONTACT "0 o o Oi LABORATORY — rvi wrrai SAMPLE analyses 03 PESTT #OF pRfesER- COMMENTS o o SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION (SPECIAL INSTRUCTIONS. CAUTION 5. ETC) o o c .3 a / zo ~o<dL6^ 3 CD J 3

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1. SAMPLED AND R^INQ. BY I. RECEI’ lY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMEf TS: SIGNjMz? S1GN:M SIGN: SIGN: PRINT:L ! PRINT: PRINT; PRINT; DATE:3^pfo 2. TIM^^j40A» DAT^j^Q^ TIME: 0}^ i FIRM: FIRM: DATE: TIME: DATE: TIME: II. RELINQUISHED BY: II. RECEIVED BY: ANALYSES/COMMENTS: V. RELINQUISHED BY: V. RECEIVED BY: ANALYSES/COMMEf ITS: 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/COMMEf TS: SIGN: SIGN: ! SIGN: SIGN: PRINT; PRINT: PRINT: PRINT: FIRM: FIRM: FIRM: FIRM: DATE: TIME: DATE: TIME: i DATE: TIME: DATE: TIME:

EVIDENCE SAMPLES TAMPERED WITH: NO YES N/A SAMPLES DISPOSED OF ON:

IF YES EXPLAIN IN REMARKS BY;