NYC-WTC_000197672

NYC 9/11 Public Portal Document

o Chain of Custody Record Samp/e Container information It 0 4418 Pottsville Pike Reading, PA 19605 Bottle Type x rd ANALWCALSERt^^ U ( G P IH ) m # of Containers CQ □ Preserved? (Y/N) o Report w Results (tJlV ^Ytutr OD lU To: State yry Wo Telephona Fax # TI w Nams Telephone t n Dept. 3 Send □ Invoice ^’'I'no Addrsss j 01 I—' u: To: City State ZIP X|Page I _ of Ct M- Credit Card Exp. Date I PAS Quote# 0 01 to I- Sampled by. Mr Vol. (L Matrix Dale Time SAMPLE DESCRIPTION or mill) Type Sampled Sampled y/' Comments/Hazards/ Location Details tn (D T 1 a.if £^r >■ < H- 2 Arc-/jiJ3-sYY. ga Zojjb)/ o tn 3 4rc.-IAi3’-sry-^i ^16 w 4

5 Arc. -131 J-sty- ^16 ivX fAAt>‘r po bii^ tn ! 6 4tc- a 7

4Tc. I!LI3, £LL 575' (D ro >** CD IO -jV /6fi u '. cn 9 13.13- 575 tn -J 10 1313. ^(O 7 5/^ '70{ eArr Special Instructions (including Data Deliverables and Turn Around Time); o 1—I

kJ Samples relinquished to Time Samples Relinquished by. Samples Relinquished t«: ] Date I Time I shipper or courier bv; to s O Samples received by: . Date Time Samples Relinquished by;

o Method of Shipmcnt/Delivery; UPS PAS Courier CK^t drop oft Other o U 1o Samples Rec'd. on Ice? { Y N /Q/a)z Temp. Blank _____ Sample Temp. x Notes : o rd co Samples rec'd intacf^^N ) Custody seals Y N Id”on samples match COC^ 1 o VOC Samples have zero headspace?! Y N tfi^l) Samples properly preserved? ( Y N/r^ o o

NYC-WTC_000197672