NYC-WTC_000199111

NYC 9/11 Public Portal Document

Chain of Custody Record Sample Container Information 4418 Pottsville Pike Reading, PA 19605 Bottle Type p-x phone: (610) 921-8833 fax: (610) 921-9667 ( G P IH ) ANALYTICAL SERVICES # of Containers CZ^ Ipo it Preserved? (Y/N) Name Report Company Results Mailing Address To:

Telephone t, ‘2f2'i’ S V j^2 * ^3- - o 6 Name Telephone if

Send Company Dept.

Invoice Mailing Address 20^86^ To; City State ZIP Al Page i of ? Credit Card Exp. Date PAS Quote# Sampled by: Air Vol. (L Matrix Date Time SAMPLE DESCRIPTION a»*4nh^ Type Sampled Sampled Comments/Hazards/ Location Details I Z’^/tg/s^ T gc y ~~ 2 6i5_, 3

4 2 £’^■'23- (/'V 2S2 5 A 6 4 7 as A 8

9 7Zr o 10 H Special Instructions (including Data Deliverables and Turn.Around TimeL ,

I—i s Samples Relinquished by: Samples Relinquished to: I Date I Time o I o Samples received by: ■ Date Time Samples Relinquished by: . Samples Relinquished to r n?le , Time o Iiz-Zt/qI I 9^.7 Io o _______ __________ UPS Method of Sliipnieiit/Delivery; I,.,, .xtr^ .,,,,,__ L /PHD-E?^ PAS Courier Client drop oft Other I Laboratory:

co o Notes : co Samples Rec’d. on Ice? ( Y ^pTt/ST Temp. Blank Sample Temp. ' I—i CT Samples rec'd intact7(^)M ) Custody seals intact?! Y N (iS)) iFon samples match C0C?M^ ) I—i CT VOC Samples have zero headspace?! Y N Samples properly preserved? ( Y N <^^)

NYC-WTC_000199111