NYC-WTC_000206871

NYC 9/11 Public Portal Document

Veritech, 175 Route 46 West, Fairfield, NJ 07004 PHONE (800) 426-9992 A Division of HAMPTON-CLARKE, INC. NJDEPE # 14622 CHAIN OF CUSTODY RECORD FAX (973) 439-1458

CUSTOMER INFORMATION REPORT INFORMATION PROJECT INFORMATION SEND REPORT TO: ) CUSTOMER: ^07^ TURNAROUND DELIVERABLES ADDRESS: (CONFIRM RUSH TATS WITH LAB) (PLEASE CHECK BOX) TELEPHONE: J. ‘ ^STARDARD FAX: □ STANDARD □ FULL □ RUSH □ WASTE □ BUST PROJECT: PROJECT MANAGER: . J □ 24 HOURS 100% □ NJ REDUCED □ EXCEL PROJECT LOCATION: rC gA SEND INVOICE TO: □ 48 HOURS 75% □ HAZSITE □ CUSTOM STATE: ______________________ □ 72 HOURS 50% ■^ELECTRONIC DELIVERABLE □ 1 WEEK 25% PO NUMBER: □ 10 DAYS 10% □ OTHER (SPECIFY)

ANALYTICAL REQUESTS SAMPLE LAB Q a TYPE No. of Bottles LU UJ SAMPLE 1— NUMBER SAMPLE IDENTIFICATION METHANOL G o UJ ANALYSIS O i/lJiSM LU ixi BOHLE # LU □J gcc 2^ (LAB USE ONLY) 2S S

00 2. y lb. /Al -r- 5 /VAX/A; Po/(^A,

r.’ie r ^/

o H __________ - i SAMPLER CERTIFIES THAT EACH SAMPLE RECEIVED PROPER FIELD PRESERVATION (IF REQUIRED) (INITIALS) I—i SAMPLE HAZARDS : FLAMMABLE SKIN IRRITANT || NON-HAZARD UNKNOWN I I NOXIOUS FUMES [ | s o o Instructions; TEMPERATURE UPON RECEIPT: o I o o co o RELINQUISHED BY: AGENT OF;_______ -■'•.r relinquished BY: /J DATE/TtME

DATE/TIME RECEIVED BY: AGENT OF: RECEIVED BY: -'O'/ 'DATE/TIME AGENT OF; / , TA 7/A 1/5/55 - - CO AGENT OF: '/'(O' on

NYC-WTC_000206871