Chain of Custody Record, Sample AE06264, March 2002

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Z o WESTc Tester county department CHAIN OF CUSTODY RECORD co OF LAB3& RESEARCH PAGE I OF L “0 SD(»» LABORATORY WESTCHESTER COL c '2 o o NAME CONTACT JI ADDRESS CONTACT VALHALLA. NEW YORK CT o' "0 o o cn — I I I III [ ■ ANALYSES LABORATORY SAMPLE PEST/ #OF PRESER- 9L COMMENTS o> SAMPLE NO. SAMPLE NO. DATE TIME TYPE VOA BNA PCB METALS CN BOTTLES VATION special instructions. CAUTIONS. ETC) O o o c 3 o I I 3

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I. SAMPLED Al lINQ. BY I. RECEIVED BY: ANALYSES/COMMENTS: IV. RELINQUISHED. BY: IV. RECEIVED BY: ANALYSES/COMMENTS: SIGt^gs^ SIGNr^^^A f SIGN; SIGN: PRINT: 'lI 0x9 PRINT: PRINT: PRINT: FIRM: FIRM: FIRM; FIRM: DATE: 3i <3/02 TIME;fW 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; 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:

EVIDENC E SAMPLES TAMPERED WITH; NO YES___ N/A SAMPLES DISPOSED OF ON;

IF YES E) PLAIN IN REMARKS BY: