NYC-WTC_000199061

NYC 9/11 Public Portal Document

T1 Chain of Custody Record Sample Container Information 4418 Pottsville Pike Reading. PA 19605 Bottle Type o ■;^vr.^i:-M»VPK3Tr«rT*4TrArATrsKifc.Mr?:Riri.»sio ;j -J phone: 1610} 921-8833 fax: |610) 921-9667 ( C P IH 1 ANALYTICAL .SERVICES' # of Containers CZ^ a |po # w Job ID Preserved? |Y/N) [ZZj> Name 6g//-zV Report Company ______________ tn -J Results Mailing Address 0)

To: /iw y^'ik "“'• /yy in>/iy "0 tn Name Telephone n ! 3 Send Company Dept. □ Invoice To; City Address State ZIP „ Kfi7Z)IOfo"i/ 01

t£ ft

0 Credit Card # Exp. Date PAS Quote// 01

Sampled by: All-Vol. (L Malri.s Dale Time tn •ACJBW^ Type .Sampled .SampUd ID SAMPLE DESCRIPTION A1/A‘^ Coniinents/Hazards/ Location Details T C A'l^ ^00 1^^^- 0 y I^^Y- hi

w 2 D irt 3

4 -Al 2 tn 5

6 □ U3 ro 7 »-• U) S m tn 9 -J Q 10 H 1"^ Special Inslruciions (including Data Deliverables and Turn Around Time);

I—i s Samples 1 elinquislied hi Date Time Samples Relinquished by; Samples Relinqiiislied to; I Date I Time o shipper or courier by; I I ' I 1 I o o o o co Samples received by;

Method of shipniciityDeiiveiy; (JPS ; I Date

PAS Courier I Time Samples Relinquished by;

Client dropoff Other Samples Relinquished (0 1 Laboratory; iixLsr -0 o Notes ; t ro co Samples Rec'd, on Ice? ( Y Temp. Blank Sample Temp. __Tr_ pj I—i o Samples rec'd intact?©N I Custody seals intact?( Y N ID on samples match COC/f^^J I i' CD VOC Samples have zero lieadsp3ce?( Y N f^I Samples properly preserved? j Y N/n^ )

1

NYC-WTC_000199061