OSHA aromatic hydrocarbon monitoring chain of custody, Oct 2001

NYC 9/11 Public Portal Document

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Chain of Custody Record So/np/e Container Information z o B c 4418 Pottsville Pike Roadino, PA 1S605 “ Bottle Type A__k ro plione: (610I 921-8833 fox: (610) 92R9667 __ f G P IH ) 'J ANAI V I ICAI. SHI{VICi;S of Containers o Preserver!? <Y/N) CZ> ~^iY£iTC □ Report □ Results TJ Io: (r> y ZIP a Cd Telupimne oQ M o Telephone f 110^1^. -0 w n H Dept. H Send Company O □ nj invoici^ Mailing Addtess o To: City tr H SlHJrt ZIP XIPage _ of r+ Cfedii Crtid If Exp. Dale O O I'AS Quote// 0 H O H S < Sampled by: Air Vol. (I. Matrix Date Time Pl H a SAMPLE DESCRIPTION ftr min) /Sunipled Sampled tn o Pl 2 X/ Comineins/Hazards/1.ocatioii,Details ID o H Pl H > 0 f 2 - IB O 3 W ■ ‘TFCr( •I N) Cp—fv- co (Pi if n 6 hd H □ 7 CD PO

to o 0^ y cn IO' u-X 01 V U OH X Special Instructions (including Data Deliverables and Turn Around Time): X x-.

Sainpli's relintiuished (o "x •' X / z<C,--Y .Dble/ Time Sauqtles Relinquished by; Samples Relinquished lt>; Time Q i I .Samples received by: Dale I'itne Samples Relinquished by; Samples Reliitqu^y^ to I Lsilxn H (0 n ;

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Samples Bttc’d. on Ice? t Y r^tw^ Temp. Blank __ Sample Temp. CD

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