NYC-WTC_000188345

NYC 9/11 Public Portal Document

FSC 4418 Pottsville Pike Chain of Custody Record Readino, PA 19605 bottle Yype Sampie Container information I TJ T

ro CD ...' a* i--. ; phone: (610) 921-8833 fax: (610) 921-9667 ( G P IH ) ANALYTICAL SERVICES # of Containers cQ o poa ro Preserved? (Y/N) CZ) O Nams CciAavV. ______________ OD Report Company N A-VC- -^GCxajL&i Results Mailing Add,eaa J DI To:

T3 V) Name Telephone I n I Dept. Send Company Mailing Addfessi3^ • Invoice To: City State ZIP z^Pagg - L of. I Credit Card # Exp. Data PAS Quote# Sampled by: ' Air Vol. (L Mairi* Date Time 43^ SAMPLE DESCRIPTION or min) Type Sampled Sampled Comments/HazardsZ Location Details 1 5u Cv>.<w i 2

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5 (n 6 o I 7 Ul re 8 I 9 CD O cn 10 cn H ■J Spccinl Instructions (including Data Deliverables and Turn Around Time); I—i

a s Samples relinquished to I Date Time Samples Relinquished by. Samples Relinquished to; I Date I Time I—i o shipper or courier bv: o Samples received by; Date Time Samples Relinquished by: . Sample.'! Relinquished to Dale Time I i o , O i Method of Shipment/Dclivcry: UPS Z _____ i I Laboratory:

i! PAS Courier Ch^t drop off Other TJ Samples Rec'd. on^lce? ( Y QM^n/a) Temp. Blank Sample Temp. ■— Noirs : OQ o Samples rec'd intact?^^ ) Custody seals intact?! Y N ) ID on samples match COC^4y^ ) co VOC Samples have zero headspace?! Y N fl7^) Samples properly preserved? ! Y N 4/a/

NYC-WTC_000188345