NYC-WTC_000223518

NYC 9/11 Public Portal Document

Chain of Custody Record Samp/e Conta/ner Informat/on (-1

01 □ 4418 Pottsville Pike Reading, PA 19605 Bottle Type ZjT tj0rjtsri3rxZJSaBscO3aKiifc-3B;'±^/»e2a-.:cstaBsr'3fitL3 ( R P IH 1 *—/ w phone: {6101 921-8833 fax: (610) 921-9667 to ANALYTICAL SERVICES # of Containers EiC^ □ |po # Preserved? (Y/N) CCQ w Nama □ ti3 Report Company a Results Mailing Address -J T3 To: /t/^ State ZIP

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(I To: City State ZIP Page i_of_i ft H- Credit Card # Exp. Date PAS Quote# 0 01 Sampled by: yt/A-CtOf Air Vol. (L Matrix Dale Time SAMPLE DESCRIPTION or min) Type Sampled Sampled to Comments/Hazards/ Location Details (0 T I a>y /7A /zi-v c M- 2 ’Ar^-o(JU-;z34hT^- o ro 3 _____________________ w 4 -< 5' /3f^ 5 03 H-* 6 a 7 uo ro 8 to 03 9 03 10 o H Special Instructions (including Data Deliverables and Turn Around Time): k; I to

I Samples relinquished (o Date Time Samples Relinquished by: Samples Relinquished to: I Date J Time shipper or courier by: I/ I o Samples received by. Date I Time Samples Relinquished by; I Samples Relinquished to I Date Time

I o I I Laboratory; o Method of Shipment/Delivery: UPS PAS Courier Client drop off OtEF o tj to co Samples Rac’d, on Ice? ( Y (^n/a) Temp. Blank ' Sample Temp. Notes ; -J Samples rec'd intact’S^N ) Custody seals intact?! Y N @ ) ID on samples match^0C?(^N 1 cn co cn VOC Samples have zero headspace?! Y N Samples properly preserved? ( Y N

NYC-WTC_000223518