Chain of custody record for sample containers, Dec 2001

NYC 9/11 Public Portal Document

Chain of Custody Record Samp/e Container information <_i

QJ 3 4418 Pottsville Pike Reading, PA 19605 Bottle Type ANALYTICAL SERVICES phone: (610) 921-8833 fax: (610) 921-9667 I G P IH 1 4 a # of Containers Ipo # □ Preserved? (Y/N) CZ> re Namu o Report Company UI Results Mailing Address l,DTVc{Ur- O □ “0 To; iao/p w ■D G Name Telephone ft tn CO n G M O Send Company 3 H Invoice Address □ Al H O To: City State ZIP u: no ft 03 Credit Card # Exp. Date O PAS Quote# 0 H £U M Sampled by: / \/] Air Vol. (L Matrix Dote Time o n H O SAMPLE DESCRIPTION or min) Type Sampled Sampled H S Commenls/Hazards/ Location Details tn < G ID M H I //-CA/1 (^0,0 »fli 6rf<} T a c

f o G 2 G S a H n M H 3 ATc- . I 6 ((KaaA,- ID G > ID G 4 S ' O 5 to 6 tn

CO 7 o U) hj 8 re tn 9 tn to tn o 10 o co 1 Q Special Instructions (including Data Deliverable and Turn Around Time): ,, plJ Jeb/D ivirft- H kJ Samples relinquished to Date Time Samples Relinquished by: Samples Relinquished to: I Date I Time 1 ro shipper or courier bv: [jlULL— I o Samples received by;

Method of ShipmcnUDelivery: UPS I Date

FED-EX^>PAS Courier Time Samples Relinquished by:

Cheilt dropoft Other Samples Relinquish^ to I Laboratory: y 7®’*® 1 i lime

o I Noles TJ o Samples Rec'd. on Ice? ( Y N^h/al / Temp. Blank _____ Sample Temp. __ o ') ID on samples match COC^^ lyl co Samples rec'd iritacj^^^ ) Custody seals intact?! Y h O 4^ 4^ VQC Samples have zero hgadspace?! Y M 50^1 Samplesproperlypresefved? ( Y t n/a 4^ ai o

NYC-WTC_000177868