NYC-WTC_000223521

NYC 9/11 Public Portal Document

o Chain of Custody Record Sampfe Container information (D 0 4418 Pottsville Pike Reading, PA 19605 Bottle Type Zr Tm; :«Tt.‘«L3!ri^.'i:.."-.^ y... •. v-'.'.’ •.■ar—;.: •._ phone: 1610) 921-8833 fax: 1610) 921-9667 1 G P IH ) ‘~/ to ANALYTICAL SERVICES # of Containers CZ^ o |PO# Preserved? (Y/NI CZ^ Name CG7/T}/ W Report Company ________________ u Results Mailing Address □ y TJ To:

■0 tn Name Telephone # n- Send Dept. n □ dj Invoice Mailing Address t£ To: City State ZIP X^IPage / of I ft M- Credit Card # Exp. Data PAS Quote# 0 DI Sampled by: Air Vol. (L Mati-ii Date Time nimlw) Type Sampled Sampled cn SAMPLE DESCRIPTION Comments/Hazards/ Location Details (D T 1 i^o ZE < H' 2 rr)}. lAQO 6oo X O ID 3 in 4 ^0 X 5 fi'rf-/2r>S''2S'^r)9~/y)r /:i7y- 6>?- 05 6 □ ID 7 ro 8 ^IL 9. /Y)^ Q 10 ----- 5 H Special Instructior^jncludin^DamJDellverables^^n^d Turn Aroun^^^n^);

s Samples relinquished to Time Samples Relinquished by; Samples Relinquished to; I Date I Time Q I—' o shipper or courier by: f l/%rA I o Samples received by: Date Time Samples Relinquished by: Samples Relinquish^ to / J Date i—Time I ___________ _ ___ .............. ......................... I Lahorutory: o o ro Method of Shipmcnt/Dciivcry: [FPS ^ED-KX^ PAS Courier Client drop oft' Other TJ co Samples Rec'd. on Ice? ( Y N^;d17^ Temp. Blank Sample Temp. , Noles: ro o Samples rec'd intact^?N 1 Custody seals intact?! Y N iKon samples match COCfS^J*.' ) VOC Samples have zero headspace?! Y N/n?^') Samples properly preserved? ! Y N/f!7^ )

NYC-WTC_000223521