Chain of custody form for Analytical Services, date unknown

NYC 9/11 Public Portal Document

a Chain of Custody Record Sample Container Information fH n 4418 Pottsville Pike Reading, PA 19605 feottle Type JZT □ phone: (6101 921-8833 fax:(610)921-9667 ( G P IH 1 *-/ u ANALYTICAL SERVICES tf of Containers □ Ipo # Preserved? (Y/N) CZ> a Nani0 CoCxA ro Report company ____________ ro Results Mailing Add,ess w g toK ifl T To: Slate ZIP

w Telephone Z/i u G tn W G Name . Telephone # n M 33 O H Send Company □ Of H Invoice ^*'“''■'’0 Address^ tOkZ^ »-> O C£ 73 To: Cily Slate ZIP ^Page^^of 9 ft H ?0 O Ciedil Card It Exp. Dale 0 H PAS Quote/' cu M O O Sampled by; Air Vol. (L Matrix Dale Time H O (fi H S or min) Sampled Sampled SAMPLE DESCRIPTION Type ID S a3 CQinmenls/Hazards/ Location Details 1 C o M I A1Lz.ILLlJ1Xs.1IL II lilb] <oa <AA lj-3 I 33 S n a H 2 A-TC - //'tisTy-S/i Iio A w r A-OO 5 ' ID M 33 HI > 3 —> -84-<:»n )to.- - — w S ' O 4

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O Special Instructions (including Data Deliverables and Turn Around Time): H ________ /)/PP ______ Z Samples relinquished to , / ./ — , __jWllE£rorcouricrbj;i__^^2j^^_^_7^^^^2^______ [ Date | Time Samples Relinquished by; I Samples Relinquished to: I Date I Time

S o Samples received by: Dale Time Ssinplcs Relinquished by: Samples RelinquisheyLtn I Laboratory: —'OA fA . Dale Time

o I I /tW o Method or Shipmen t/Dclivery; UPS <Z ['TLD-H>^Q PAS Courier Client drop-ofF OtHer “0 1 o Noles : o Samples Rec'd. on Ice? ( Y Temp. Blank ------- Sample Temp. — co Samples rec'd intact?{^N 1 Custody seals intact?! Y N iipS-t ID on samples match COC705 N ) IC. (JI VOC Samples have zero headspace?! V N ygpl Samples properly preserved? ( Y N ^Taj)) co <C’

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