NYC-WTC_000197653

NYC 9/11 Public Portal Document

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Chain of Custody Record Sample Container Information^ 01

4418 Pottsville Pike Reading, PA 19605 ““ Bottle Ty^ phone; (610) 921-8833 lax: 1610) 921-9667 I G P im ANALYTICAL SERVICES # of Containers cQ o ro !po # Preserved? {Y/NI tZZ> a Nams Report company o W . □ Results Moiling Address , <> TJ

To: i/ea.' S‘a»« X/ Telephone . "D tn n Name Telephone # 0 Dept. □ Send <( 0) Mailing Address invoice <1 ft To: City State ZIP ZfPage V of t 0 Credit Card # Exp. Date fit PAS Quote/' {Sampled by: AlrVoL(L Matris Date Time 0 OF rniis)- Type Sninpled Sampled ID SAMPLE DESCRIPTION Comments/Hazards/ Location Details T ZVj C /- 1 Ute, ois'j.fTy ' K 9 Ar) fA/Xvvv O tz- (6 (■i6o W c ’ de >oto./>jTy- (:)60 4 - jT7- Kk S I Cvvvfl. 9 KciiaK • m 5 H* o 6 to ro 7 to S 0 0 9 -J

o 10 _1^——L-—1——1 I H Special Instructions (including Data Deliverables and Turn Around Time);

to s O I—i Samples relinquished tn shipper or lotirier by: Time Samples Relinquished by: I Samples Relinquished to: I Date j Time

o Samples received by; Time Samples Relinquished by; . Samples Relinqi^ed to t 1 Date .Time I o o ■d I I Lahnratorv: ( /T/G^------ ^y/ J ■0 o Method of Shipmcnt/Delivery: UPS Q^D-EX^PAS Courier Cli^t drop~oIT CHHer co ro o Samples Rec'd. on Ice? ( Y NZnTa) Temp. Blank Sample Temp.___ Notes ; Jia (71 Samples rec'd intact^iN ) CusraOy seals intact?! Y Fd on samples match CO CO CJI Ji^ VOC Samples have zero headspace?! Y N,^7^| Samses properly preserved? ( Y Ni

NYC-WTC_000197653