Chain of Custody Record, Analytical Services, Reading PA

NYC 9/11 Public Portal Document

■n . Chain of Custody Record Sample Container Information fl) cr 4418 Pottsville Pike Reading, PA 19605 Bottle Type __ i ( G P IH ) *—/ phone; (610) 921-8833 fax: (610) 921-9667 ANALYTICAL .SERVICES # of Containers □ |po7 -»*»o Preservect? (Y/N) CZ> rd

Name cxANv-e>' Qo V □ Report Company U Results CD 01 To: State ZIP /Oif/O

w T.l«phon.^^^, G T ro CD G Nama Telephone f n M O Dspt. 2) H , Send H O Invoice Addross ; ;20-X(52O2Yr)- □ 1)1 CO G Tl To: City State ZIP ^Page t of I Ct O H M Cradil Card # Exp. Date s' PAS Quote// n 01 O O H O Sampled by:___________ ' Air Vol. (L Mairk Dale Time Hl S < G SAMPLE DESCRIPTION -•ja^ Type Sampled Sampled Coinments/Hazards/ Location Details to M Hl fl) a ( 1 O M 1 til/ Ltfsigrbu^' < G s a H 2 Ai? n M Hl fl) G > 3 w S ' O 4 to 5 m 6 w □ M to nj ro H CO to CD o 9 0) o -J co in o Special Inslruclioiis (including Data Deliverables and Turn Around Time): H K I Samples Relinquished by: Samples Relinquished to: I Date I Time to I I o Samples received by; Date Time Samples Relinquished by: Samples Relinquished to I Laboratorv: D.’tc 1 Time zffot. I 730 o I Method of Shipmentnteliveiy: UPS (TED-5X^ f>AS Courier Client drop otf OtllLT o ■a o Samples Rec'd. on Ice? ( Y(^^n/a) Temp. Blank Sample Temp. -- Mules : co m Samples rec’d intact?(V^ ) Custody seals intact?! Y N i^ ) iF on samples match COC?jQn ) IC. VOC Samples have zero headspace?! Y N jjTa)) Samples properly preserved? ( Y N rfi/aJl co o

NYC-WTC_000177925