NYC-WTC_000206870

NYC 9/11 Public Portal Document

’/I / <- P. eP .Uj" Veritech, 175 Route 46 West, Fairfield, NJ 07004 PHONE (SOO) 426-9992 A Division of HAMPTON-CLARKE, INC. NJDEPE # 14622 CHAIN OF CUSTODY RECORD FAX (973) 439-1458

CUSTOMER INFORMATION REPORT INFORMATION PROJECT INFORMATION CUSTOMER: ____ _ SEND REPORT T0:__4}e£-Li^_k TURNAROUND DELIVERABLES ADDRESS;_____________________________________ (CONFIRM RUSH TAT’S WITH LAB) (PLEASE CHECK BOX) TELEPHONE:__________________________ ^TARDARD □ STANDARD □ full □ RUSH □ WASTE □ BUST PROJECT:. ___ LtEiflZJvx. PROJECT MANAGER:__________________________ □ 24 HOURS 100% □ NJ REDUCED □ EXCEL PROJECT LOCATION:___________________________ SEND INVOICE □ 48 HOURS 75% □ HAZSITE □ CUSTOM STATE:__________________________ □ 72 HOURS 50% □ ELECTRONIC DELIVERABLE □ 1 WEEK 25% ^^^THER (SPECIFY) y pQ U— 5 PO NUMBER: __________________________ □ 10 DAYS 10%

ANALYTICAL REQUESTS sample LAB Q o TYPE No. of Bottles UJ SAMPLE METHANOL NUMBER SAMPLE IDENTIFICATION BOTTLE# Ld UJ _l co m O ANALYSIS o cc (LAB USE ONLY) 2S S o CD

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H SAMPLER CERTIFIES THAT EACH SAMPLE RECEIVED PROPER FIELD PRESERVAT ON (IF REQUIRED) (INITIALS) I—i SAMPLE HAZARDS ; flammable QJ SKIN IRRITANT | [ NON-HAZARD| | UNKNOWN [~~~| NOXIOUS FUMES Q s a o SPECIAL TEI^PERA^URE UPON RECEIPT: BkICTDI l<-TIOklC. o I IM J I nW I I VIM-,. // o RELINQUISHED BY; DATE/TIME RECEIVED BY: DATE/TIME

t o co o AGENT OF: I AGENT OF: DATE/TIME RECEIVED BY: // I DATE/TIME RELINQUISHED BY: CO O AGENT OF: I AGENT OF: c/ I LO

NYC-WTC_000206870