Chain of custody form, analytical services, Nov 2001

NYC 9/11 Public Portal Document

a Chain of Custody Record Sampfe Container information 'll o 4418 Pottsville Pike Reading, PA 19605 Bottle Type __ i Q I G P IH ) *—y tjJ phone: {610) 921-8833 fax; (610) 921-9667 ANALYTICAL .SERVICES # of Containers o Ipo a Preserved? (Y/N) EZ> Namo o (2o\av\ IV Report Company 4'jo rv LJ Results MBitinoAddrBBs^^l^ TI &/ To; Yoa to TJ tn Nama Telephona it ,1^ n

Send Company Invoice Mailinq Address^ 2^ Dept, 35 3 11

iS. ZIP % To; Cily Slate Page ft

Credit Card ft Exp. Date n PAS Quote// EU

Sampled by: Air Vol. (L Matrix Date Time -z tn SAMPLE DESCRIPTION or min) Type Sampled Sampled Coinmenls/Hazards/Location Details ni I 1 4n: -//^7-/T/- 5// 11 Ml Aoo^ lf-3i < 7/4 M-

o 2 ATc _ 7 -Yiy-Sfji iAp Z X r iCoo SO I fD —> -g^-Qrrrs:------ -- — = 71 1 Are - //J^.Y77' S'/j 4 5 tn G □ ID 7 rv S AT^- JlJi-i-5Ty-H3 vfrt? CD tn 9 fi Cl o 10 i ri Special Instructioni (including Data Deliverables and Turn Around Time): TP ufitk s Samples relinquished Io . / /. /L-r-~ . Oate Time Samplci Relinquished by: Samples Relinquished to; j Date I Time o o shipper or courier by: _____ ' [ ///A7iit.'l | I o Samples received by: Date Time Samples Relinquished by; Samples RelinquishjtUa 1 o o 1 Laboratory: I co Method of ShipmentyDtiivery; UPS^ PAS Courier Client drop off Other ■0

Samples Rec'd. on Ice? t Y ^0^ Temp. Blank __ - — Sample Temp. — Noles : <1 Samples rec'd intact/f^N 1 Custody seals intact?! Y N rCg4 ID on samples match COC?^Y’N 1 cn VOC Samples have zero headspace?! Y N /ffaP) Samples properly preserved? ( Y N

NYC-WTC_000182786