NYC-WTC_000197405

NYC 9/11 Public Portal Document U U Chain of Custody Record Sampie Container information 1

4418 Pottsville Pike Reading, PA 19605 Bottle Type in phone: (6101 921-B833 fax: |610> 921 9667 ( G P IH I ANALYTICAL SERVICES # of Containers ly 111 Ipo# Job 10 Preserved? (Y/N) cr> <3 ry Report Company N Results Mailing AddrasB 2 ■3

To: Telephone i=Bx 6 □ <0 11 Name Telephone t 11 Dept. 3 Send Invoice Mailing Address XI 16^3^1 ru

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To: Chy state ZIP y]Page / _ of _'7 Credit Card K Exp. Date 0 PAS Qiioteifif (11

Sampled by: Air Vol. (L Matrix Date ThlK 01 SAMPLE DESCRIPTION »i Ulin) *■ Type Sampled Sampled n Coinmenis/HazardsZ Location Details c P ih^la o & 2 (D in 3 fi 4 p J 01 / e /Ac^ o to > 7 W

to li 8 z^c? /CrW 6 tn 01 f 9 /iTe- r 10 /f^,a V Special Instruclionj (including Data Deliverables and Turn Around Time): o n Time Sample! Relinquished by: Samples Relinquished to: I Date ( Time I rc hC 1 Io Sam (tics received by:

Method of ShipmenlZDelivcry: DPS ^FED-^X^ Date

PAS Courier Time Samples Relinquished by:

Client drop ott' Other Samples Relinquish^ to / Laboratory: </z . Date , Time

-a o 1 o Samples Rec'd.xm4^e? ( Y N g53i Temp. Blanks ______ Sample Temp.____ Notes: ro o Samples rec'd intact$iX^ 1 Custody seals intact?! Y ID on samples match COCjg N I co o ______ VOC Samples have zero headspace?( Y ) Samples properly preserved? ( Y hTnZi r\j

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NYC-WTC_OOO1 97406