NYC-WTC_000189692

NYC 9/11 Public Portal Document

Chain of Custody Record Samp/e Container information CM 4418 Pottsville Pike Reading, PA 19605 Bottle Type Z37 (L phone: (610) 921-8833 fax: (610| 921-9667 ( G P IH 1 1 ANALYTICAL SERVICES ft of Containers |po Id Preserved? (Y/N) Mama {2oV, A Report Company ATc- Results To: C'tY State f/y ZIP > CD Telephone It CD CD Name Telephone # CM 0) Dept. O CD Invoice bdailing Address To: City State ZIP X|Page _ I R026I60I2 of I —■ Credit Card # Exp Date V) PAS Quote# 0) u Sampled Air Vol (L Matris Date Time rt SAMPLE DESCRIPTION Tjpe Sampled Sampled 5 / Commeiiis/Hazards/ Lcxation Details 1- 0) CD ' ArC'/2ii^ <^rv, 6- 2

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10 O fl) Special Instructions {including Data Deliverables and Turn Around Time): H 00 CM

O Samples relinquished (a Date , Time Samples Relinquished by: Samples Relinquished to: I Dale I Time So shipper or courier by: 1 I—i CM Samples received by: j Date I Time Samples Relinquished by; Samples Relinquished t^ . ■ Date . Tj^ o o Q I Laboratory: t I I o □ Method of Shipment/Deiivery: UPS fAS Courier Client drop off Other o co Samples Rac’d, on Ice? ( Y N ^1'^ Temp. Blank 2ZZZZ Sample Temp. Notes : o co c Samples rec'd intac^^N ) Custody seals intacPl Y ID on samples match COC/OJv ) m co n VOC Samples have zero headspace’( Y Samples properly preserved? ( Y Nz<S7^)

NYC-\/VTC_000189692