NYC-WTC_000218481

NYC 9/11 Public Portal Document

QL FSC 4418 Pottsville Pike Chain of Custody Record Reading, PA 19605 Bottle Type Samp/e Container Information

Phone:(610)921-8833 fax:(610)921-9667 I G P IH ) AN?\LYTICAL SERVICES # of Containers |PQ # Preserved? (Y/N) [=> Nam 8 Ce>//A/ Report Company /h:.^c^7k£ Jz»^. Results Mailino Address To: (X) to tn ^hona * 5a N Nama Talephone t tn o r-t Send to Invoice t^^Uing Address Zn7y

To: City Slate ZIP tn Credit Card # Exp. Data lU PAS Quote# o ■M Sampled by; Air Vol (L Matrix Dale Time > SAMPLE DESCRIPTION .nr iiihry- Type Sampled Sampled L Coinincnis/Hazanls/ Location Dclails W to 1 |?yTyp^ 2 0 •K 3 /}rc-e>2cs-~2i p J) (“I 4 //c 1/ 5 10 c 6 CE

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9 O ft. r- Special Instructions (including Data Deliverables and Turn Around Time): *

I n a OJ Samples .elinquished to shipper or courier by: ( Samples received by; ' / // . Dale,

j Date I Time

Time Samples Relinquished by;

Samples Relinquished by: Samples Relinquished to:

. Samples Relinquished to I Date

yuale I Time

'lime o I Luboratory;

I CD Method of Shlpmcnt/Delivery; ^fcb-EX^ PAS Courier CH^t drop otl' Qther a It Samples Rec’d. on Ice? ( Y^Jn/a) Temp. Blank Sample Temp. " Notes; It Samples rec'd intact^l^N ) Custody seals intact?( Y N 1 ID on samples match C0C?(£^ I u. _______ VOC Samples have zero headspace?! Y N ^$) Samples properly preserved? (YN ^/^

NYC-WTC_000218481