Chain of custody form, analytical services, Nov 2001

NYC 9/11 Public Portal Document

Chain of Custody Record Sampfe Container information 4418 Pottsville Pike Reading, PA 19605 Bottle Type Phone:(610)921-8833 fax:(610)921-9667 ( G p IH 1 l=> ANALYTICAL SERVICES # of Containers 1=:^ IPO # Preserved? (Y/N) ■— ' - *88=!^——-=g^gBB——BH

Name ___________________ Report Company Results A'A c 3*^ - Mailing Address i; To: State X/y Z’P/^OZo

Name Telephone S

Send Company z- D’P*- Invoice Mailing Address To: City State ZIP age I of Credit Card # Exp. bate PAS Quote# Sampled bv:ViWi* /7,.a7u Air VoL (L Matrix Date Time SAMPLE DESCRIPTION ’Oirmin)” Type Sampled Sampled y/' Comments/Hazards/ Location Details 1 fhy' Z7? t wrs- *z 2 i jij j ■- jZ11 L M'fx. 3 _iiJ_ 4 /hr J I - J" ri 5 /Hr . y J i - .5 < Z ih ♦ /' 6 4T<; " 7 4Tr - f - ^7 ib 3<?j gvu'___________ 8 fire - '-E______ iCoov-’ _________ Q 9 /hr., fijf - /< I 5J JV? ^• H K 10'/lie ... Hji- ■ V ,r 5'/-L. I Special Instructions (including Data Deliverables and Turn Around Time): K)

O S - '- -‘A. 4- Date , Time Samples Relinquished by: Samples Relinquished to: I Date I Time o o i I Samples received by: Date I Time Samples Relinquished by; . Samples Relinquished to I Date I Time o o I Laboratory: co Method of Shipmentaieiivery; IT’S ^FEU-EXPAS Courier Client drop oil Other o Samples Rec'd. on Ice? ( Y N ri7a) Temp. Blank Sample Temp. Notes : co Samples rec'd intact?{Y N ) Custody seals intact?( Y N n/a ) ID on samples match COC?( Y N ) VOC Samples have zero headspace?! Y N n/a ) Samples properly preserved? 1 Y N n/a )

NYC-WTC_000182778