Chain of custody record for analytical samples, Jan 2002

NYC 9/11 Public Portal Document

Chain of Custody Record Sampfe Container information (u □ 4418 Pottsville Pike Reading, PA 19605 ““ Bottle Type .—a ro ANALimCALJ^^ ' L I n P IH ) m # of Containers □ Preserved? (Y/N| !=:> ro |n«"« Ch»\\V\ o CD Report Company a Results Mailing Address ro ( (lTa '^UzjY Tl To: /l&o yo I' K SistB /// ap /pofc T w 0) G Namo Telephone # n W H Dept. Send O H H Invoice l'^®'''nfl Address /)Zol6)Z5i^ □ lU

(I O ZIP To: City Slate rfl Credit Card tl Exp. Date £9L=L^2L=1 ft H Fl O PAS Quote// 0 QJ Pl o o Sampled by <7[J Air Vol. (L Matrix Bale Time H O Type Sampled Sampled CD H S SAMPLE DESCRIPTION Comments/Hazards/ Location Details______ ID < T H H a i 1 oXti'ieori by (littIS. ictreuSACa. C O H ti't ^^lorrt Loloby Fl S 2 AXc. ekU- - pc 0^ n a H ID M Fl H > 3 ATc-t^WS /^e> W

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5 ATc-oA3-ng3j - ^^Z^zE2ZZZZZZZZ= N> 6 /3-rc -oUS-KgJy- PcOc □ w Fl nj 7 H8V- Arc-a 112- Mgjj- pct^^ 5^Z5^SZZZZZZZZ CD ro H 8 iA<> CD cn 9 /LzFTly/2 cn to o o 10 ftrc-cAj-HX]7- pcGu eicci^k ' I" co o Special Instructions (including Data Deliverables and Turn Around Time): H Samples Relinquished by. Samples Relinquished to: I Dale I Time

o S Samples received by Date Time Samples Relinquished by. . Samples Relinquish Io r I Laboratory. Date Time I—i o o Method of Shipment/Delivery UPS TEtR PAS Courier Client dropoff Other -D I Notes ; o Samples Rec'd. Qji..lce7 | Y N i/a Temp. Blank Sample Temp. rj o Samples rec’d intactj^^YJ^ ) Custody seals intacf'l Y I^PYl^P ID on samples match COC^Tvyj ) co iTg cn VOC Samples have zero headspace7{ Y hT'TtTFT Samples properly preserved? ( Y Y^Yf/a |

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NYC-WTC_000179436