Chain of custody record for sample containers, Dec 2001

NYC 9/11 Public Portal Document

a ID P

Chain of Custody Record Samp/e Conta/ner Informat/on CD 4418 Pottsville Pike Reading, PA 19605 Bonle Type analytical services phone; (610) 921-8833 fax; (610) 921-9667 ( G P IH 1 Y' co

# of Containers Ipo7 Preserved? (Y/N) o Namo U ~Scx,v^ez> Qo'Yv\ CD Report Company hl Results ' To: w G X/ z&ola T3 CD IS n G M 3 o Name Telephone # H 3 01 H Send Company Dept. O G Invoice Mailing Address I A- pll^' U c+ ?3 O To: City State ZIP y^Page \ of O 01 H M Credit Card # Exp. Date PAS Quote# O O H O Hl < S m Sampled by: w Air Vol. (L Matrix Date Time CD ft 3 M Hl SAMPLE DESCRIPTION or mln) Sampled Sampled < a Z^Comments/Hazards/ Location Details o M ?3 a S H 1 acf 717^ Sack f (c^rgwAcI 0 IB M Hl ?a > 2 4'Tc^ YtLif W

S o ' 3 ex, 6 (gy^k J* (l/o? gCawK ■I cn to 5 □ co CD M 6 W h3 H CO m to 3 m o >0 o 2 co O H IM ____________ L_J_^______ Special Instructions (including Data Deliverables and Turn Around Time); 1 K I

I o Samples relinquished to shipper or courier bv; Samples received by; /Iv/I / ' Dale Lillie Date Time

Time Samples Relinquished by;

Samples Relinquished by; Samples Relinquished to;

Samples RelintKriJhed Co ; I Dale

Dm® I Time

Time o I Lahorutpry: TJ I o o Method of Shipinent/Delivery: U'PS Ms Courier Client drop ott' Other cn co Samples Rac'd, on Ice? ( Y N Temp. Blank Sample Temp. .Volts ; tLG Samples rec'd intact^Y)N ) Custody seals intact?) Y ID on samples match CQCfT^N | CR VOC Samples have zero headsoace^l Y N Samoles oroperly preserved? I Y Nfn/^U CO

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