NYC-WTC_000194786

NYC 9/11 Public Portal Document

Chain of Custody Record Samp/e Container information 71 . til O' 4418 Pottsville Pike Reading, PA 19605 Bottle Type j_ x it- ( G P IH 1 00 # of Containers O PO * JoblD/^/^5-^ Preserved? (Y/NJ C=> ru Name \ouv»^e>!A Co V14 ______________ Report Company kTC- icitocajj^ Jkc UI Results Mailing Address |o 5 hrx*/' 113 At To:

T U) Name Telephone # n Company Dept. Send ''V X □ InVOiCG Address < _ (70^0 novizg Al 1-*

/^|Page > of t (C To: City State ZIP ft Credit Card # Exp. Date PAS Quote# 0 At Sampled by: (ff/ AlrVoL(L Matrix Date Time SAMPLE DESCRIPTION or iiibi) Type Sampled Sampled yZ Coininents/Hazards/ Location Details w (A T I f^o et/V i Ml. ^a>o < M- 2 /ire-'ai H- i^O 0 n J Art., If- iSe /too (/• w 4 ATe.^01.11 -ifoH- titmA- 5 tn £ o 7 (D l\) 8 CD 0) 9 ff) Q 10 -J H Special Instructions (including Data Deliverables and Turn Around Time);

I—i s o Samples relinquished lu Samples Relinquished by: Samples Relinquished to; I Date I Time shipper or courier bv: o o Samples received by: I Date I Time Samples Relinquished by: I Samples Relinquished to Date .Time I I Laboratory: o o Method of Shipment/Deiivery: Ct’S Z tOD EX AS Courier Client drop off Other I—i I tJ on Samples Rec'd. on Ice? ( Temp. Blank — Sample Temp. — Notes I I—i ro I—i Samples rec'd intactT^N ) Custody seals intact?) Y N tjOtf) ID on samples match ) on ______ VOC Samples have zero headspace?! Y N Samples properly preserved? ( Y N

NYC-WTC_000194787