Chain of custody record for sample container, Reading PA, 2002

NYC 9/11 Public Portal Document

nHia -n ro Chain of Custody Record Samp/e Container information CT

■I ^418 Pottsville Pike Reading, PA 19605 Bottle Type __s vcx3Sia:i'»«3KZ2i:«ciU£ti*ssRS(:sA.e«=ra«aeQiKBMa phone; (610) 921-8833 fax: (6101 921-9667 I R P IH ) ‘-y o ANALYTICAL SERVICES # of Containers c:^ rv Ipo # Preserved? (Y/N) C=> Q 4^ Name ^CW>A-.-Xl CjO VvW_______________ Report Company rc ^s^ocXcug^, j: tD "0 Results Mailing Address To: T w cn G n ro Name Telephone # G 3 ro 3 o Dept. H Send Company fu H Invoice Mailing Address (£ O z^* ft ro To; City State ZIP Page | of ( ro n o Credit Card If Exp. Date Cu H PAS Quote# ’x ro Sairipled by: ji/ o o Air Vol (L Matrix Dale Time tn H o m H S SAMPLE DESCRIPTION or min) Type Sampled Sampl eri < ro Conunents/Hazards/Location Details T ro H < o a ro I atr hrf(? 0 ro s 2 a H ut ro H ro > 3 #rc - S - M «1#-1*^3 S ' 4 - (A 2q tt-Kt o cn 5 Siatvk SIolAiA to o 6 CD CO ro M 1 hj til H S tn tn 9 <1 O O 10 CO Q Special Instiucliuns (including Data Deliverables and Turn Around Time): H K Samples Rciinqiiisiied (o: j Date I Time I Date Time Samples Relinquished by: to X::SiX" feW' a -r^rra/V I I I o Samples received by; Date I Time Samples Relinquished by: Samples Relinquished I Lahnraloi-y; / Daly" Time

7J o Method nf siiipincni/Delivcry; IJPS Z PED-EX ) PAS Courier Client drop off Other I o 1 Samples Rec'd. on Ice^—Temp. Blank __7^ZZ Sarnple Temp, Notes ; W o I co Samples rec'd intaqtTy?^ 1 Custody seals intact?! Y N ID on samples match ' co VOC Samples have zero headspace?! Y N X?/^ Samples properly preserved? ! Y N ztTa'T o co I

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