Chain of Custody Record, PSC, Reading PA

NYC 9/11 Public Portal Document

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PSC B 4418 Pottsville Pike Chain of Custody Record Reading, PA 19605 Bottle Type Sample Container Information 0

to □ phone: {6101 921-8833 fax; (610! 921-9667 ( G P IH I ‘-Y ANALYTICAL SERVICES ot Containers C> a ipo # ru Preserved? (Y/N) cr> ui Nams (^tXsez^gZ) QjVv\_________ m Report Comp any AT<L. ^jZqcCzJ^ Results To: State yy ZIP / go Io tn w Cl G ro X H Name telephone □ o at H Company Dept. t-* Send t£ H ft O Invoice Addrass m 0 hi To: City State ZIP Z^Page -.1-, L \ bl o H Credit Card # Exp. Date M PAS Quotes tn O O ID H H O S Sampled by: / \/J Air Vol. (L Matrix Dale Time T < m SAMPLE DESCRIPTION or min) Type Sampled Sampled C p] H Comments/Hazards/ Location Details o 73 O Fl a H S H H ZML_ Orf 1^0 i zz Xcw»»t // 3 0 ID tfl

ht > S G ' i ATc- PC|?.i O m /^oa^ 71^ Q tn w s / CooKfyari^ /i/or}\ w p] h3 H 7 7 tn tn tn to s I <1 o 9 •/ o T co 10 i o Special Instructions (including Data Deliverables and Turn Around Time): 1-3 K 1 , Dale , Time Samples Relinquished by; Samples Relinquished Io- Samples relinquished to I Date Time so shipper or courier bv: f v" f iv 1 // /fff i I Samples received by: Date Time Samples Relinquished by: , Samples Relinquirhed to I 0»te Time I—i o 1 1 ' Lahoratorv:/ •n o Method of Shipment/Delivcry: QPS Z T0Q 1 CEX^AS Courier client drop off Other w o /OCtQ o co Samples Rec’d. on Ice? ( Y N Temp. Blank Sample Temp. _____ — >otM :

Samples rec'd intactSy^ 1 Custody seals intact?! Y 1 ID on samples match COC(^ Il I CR O VOC Samples have zero headspace?! Y N I Samoles oroperly preserved? 1 Y N fiWi

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