NYC-WTC_000197646

NYC 9/11 Public Portal Document

Chain of Custody Record Samp/e Container information 4418 Pottsville Pike Reading, PA 19605 Bottle Type _ k phone: (610) 921-8833 fax: (610) 921-9667 ( G P IH') ANALYTICAL SERVICES # of Containers ~ ~_ IpoT •*****” Preserved? (Y/N) [CZ^ Name

Report Company Results Mailing Address b7c J-ftC- y To: Telephone *^5-^J, ^2^0 Fax

Name Telephone #

Depl. Send Cumpaiiy Invoice Mailing Address To: City State ZIP Z'|Page 7 of / Credit Card # Exp. Date PAS Quote# Sampled by: Air Vol. (L Mairis Dale Time SAMPLE DESCRIPTION ee ndn^ Type Sampled Sampled Coniments/Hazaids/ Location Details 1 2

3 ^30 \// i}^fC~e2e6 y~ A1< 4 4 5 6

7 £ 9 lU n H Special Instructions (including Data Deliverables and Turn Around Time);

Time Samples Reliriqiiislied by: Samples Relinquished tn: I Dale I Time s o 1 I—i o Samples received by: . Date Time Samples Relinquished by: Samples Relinquished In I Dale I Titiie

I o I I Laboralorv; o Melbud of SliipineiitZDelivery: UPS Pas Courier Client dropoft Other o co Noles ; o Samples Rec'd. on Ice? ( Y N 'nTaf Temp. Blank Sample Temp. Samples rec'd intact?(Y N ) Custody seals intact?! Y N n/a ) ID on samples match COC?( Y N | co VOC Samples have zero headspace?) Y N n/a ) Samples properly preserved? ( Y N n/a )

NYC-WTC_000197646