NYC-WTC_000206875

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

REPORT INFORMATION 1 PROJECT INFORMATION CUSTOMER INFORMATION CUSTOMER: ADDRESS:_ SEND REPORT TO:. TURNAROUND DELIVERABLES (CONFIRM RUSH TAPS WITH LAB) (PLEASE CHECK BOX) TELEPHONE: .^t^TARDARD /^Standard □ full FAX:__________ _____ PROJECT: VCriZO-fVl5gjg*!gWEgSM^^i38 □ RUSH □ WASTE □ BUST PROJECT MANAGER: SEND INVOICE TO: Oeti^eclA □ 24 HOURS 100% □ NJ reduced □ EXCEL PROJECT LOCATION: □ 48 HOURS 75% □ HAZSITE □ CUSTOM STATE:____________ □ 72 HOURS 50% □ ELECTRONIC DELIVERABLE PO NUMBER: □ 1 WEEK 25% □ OTHER (SPECIFY) □ 10 DAYS 10% ANALYTICAL REQUESTS

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Q mil H K I SAMPLER CERTIFIES THAT EACH SAMPLE RECEIVED PROPER FIELD PRESERVATION ( F REQUIRED) (INITIALS) s o SAMPLE HAZARDS : flammable Q SKIN IRRITANT Q NON-HAZARD | | UNIIKNOW^r/f^y-y^ NOXIOUS fumes □ I o o o o co SPECIAL INSTRUCTIONS: RELINQUISHED BY: JE/TIME RECEIVED BY: Ct )It« PERATURE UPON RECEIPT: 1 dAte/time __ o AGENT OF: ?2l____ AGENT OF: to RELINQUISHED BY: JE/TIME RECEIVED BY: x DATE/TIME co co co AGENT OF: AGENT OF: I

NYC-WTC_000206875