Chain of custody form header for environmental testing, Feb 2002

NYC 9/11 Public Portal Document

V-r--- Tt cr 4418 Pottsville Pike Reading, PA 19605 phone; (610) 921-8833 CHAIN OF CUSTODY Page 1 W 03

L of o fax; (610) 921-9667 or 921-8407 rJ PO« Quote# O 03

Report Name Tq Kw JOB ID: UI Company re Results Mailing Address Tt S' toru ANALYSIS REQUESTED “0

To: Slats ZIP /do/r! Use attachments if necessary. Telephone J g 2.5 C FaxJ^ . 12JLL Please specify method requirements. Preservatives Key: T Name in w A = Ascorbic Acid n G to Submit Company C = net N2 = NaS2O3 33 G M Mailing Address H = HNO3 S =H2SO4 □ O H Invoice City State ZIP I = Ice ;Z = ZnAcetale tu

H To: 1 elephone # Fax# J N = NaOH X = None (£ ft

1 O Credit Card Info (include exp. dale) 3 0 73 Hl Sampled by: Sampling Location (Specify Slate)' O = Other:_____ O H M Due Date; (Rush TAT requires Lab approval) s tf> O o m H o REPORTING REQUIREMENTS (Circle all that apply) tS 3 < 3 Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key; M list all that apply) a 0 O H UST NPDES MIPP RCRA Stormwater DEP (PWS # 73 3 ) Type (P-Ptaslic, G-Glass, A-Air) a H r w % M 73 > s SAMPLE DESCRlPTlOxN Final Air Voluim Matrix Type Sampling info Container Volume (Liter, etc)

3 E (ID must match container labels) (L or mill) Date Tune rrumber of Containers O CL^ tn 1 go to 2 a co 3 rd CO M U) 4 H m 5 m 6 O O 7 CO Q R H 9 l"^ NO to I—i

(1) Relinquished by. Dale T i( n e (2) Received by. Dale I inie (3) Hciiiiquished by: Date 1 me .z/xt/’h “0 o o (4) Received by; Dale lime (b) Rulincpiishcd by: Cate i line (6) Received st Lab; Time I rd o o co Method of Delivery: UPS ED-EX PAS Courier Client US Mail Other co NO NO cn CO

NYC-WTC_000175663