OSHA aromatic hydrocarbon monitoring chain of custody, Oct 2001

NYC 9/11 Public Portal Document

PSC 6 4418 Pottsville Pike Chain of Custody Kecord Reading, PA 19605 Bottle Type .T Samp/e Conta/ner fnforma t/on

phone: (610) 921-8833 fax: (6101 921-9667 I fi P IH 1 *—/ ANALYTICAL SERVICES’ # of Containers T> PO g Lurg/ ODO Job |°. /P Preserved? (Y/N)

Report OmpanY , Tk/g-. Results Mailing Addiass 5TT To: CD Stato|KjT ZIF(OQ(Q C! w relephona

O Name Telephone A H Send Convanv O n Invoice Mailing Address TT ZIP o H To: City Stats Xi Page _ I of td Exp. Dalo o o Credit Card ft PAS Quote^^ H O H 2 < Sampled by; Air Vol (L Matrix Date Time PI i-i or min) Type Sampled Sampled a SAMPLE DESCRIPTION y/ Commcii(s/Hazards/ Location Details o M O H 1 i tlo - ricef T/Xi Tis PJ H > 2 |\ H 4T7 f 2: '' 3 11 ■ o 4 ' fffc lUOXA-O"! A / p 5 . Arc- (iVo-fTpf4 11 7 w W I 5 ZTc- (11Q - 3iX X 7 Arc(Uo-.H^I^b»L g AT ( A (3 CT 005 (o CO 9 Arc; I (Q -TUKI CT St 10 Special Instructions (including Data Dciivcrabicj and Turn Around Time):

Samples relinquished lo"^ T tX i .Jf*'®/ "7. Time Saw plcJ RclioquElicd by: Q SamplH Relinquished to: J Dale J Time shipper or courier bv! ..,-^T/TTYt?TlA-. |H^|27(O/ | H L3' Samples received by: __ . Date Time Samples Relinquished by; I ro » I—i S Method of ShipraeBt/DclIvcry: UPS W3aa:>:a PAS Couner Chent dropott Oth^ J Samples Rac'd, on Ice Temp. Blank Sample Temp. Noles: I o I Samples rec’d intaXt^N-) Custody seals intact?! Y ld(^ I ID on samples match CQ ST I I VOC Samples have zero headspace?! Y Ni^/aJ? Samples properly preserveo’? ( Y T I

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