NYC-WTC_000226984

NYC 9/11 Public Portal Document

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Chain of Custody Record Sample Container Information 0) □ 222!Z552IZ^5S 4418Pottsvill0Pike Reading, PA 19605 Bottle Type ZjT o -J an/s/!cal»”• I G P IH I # of Containers C=) O rc PO # Preserved? (Y/N) □=> Name Report O ro Results Mailing Address 01

To: Telephone * ChS -0 (fl Name Telephone /I n

Send Dept. □ 0) Invoice Address (£ Ct To; City State ZIP Xr^ge j of 2^ O Credit Card ff Exp, Date PAS Quote# 01

Sampled 2 Air Vol (L Matrls Dale Time tn Type Sampled Sampled (D SAMPLE DESCRIPTION Comments/Hazards/ Location Details T < H, 0 2 _J___ L__WX (D W

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I o Samples relinquished to shipper or courier bv: / t/jf j Samples Relinquished by:

Samples Relinquished by; I Samples Relinquished to: I Date I Time

o Samples received by; Date Time Time I o o Method of Shipment/Deiivery; UPS Q f ED-E?^X PAS Courier Client drop off Other —— / z' TJ CO Samples Rec'd.opj^e? ( Y NztIT^ Temp. Blank Sample Temp._____ Noles ! ru CPi Samples rec'd intac(f[YJ^l CusTOtIvseals intaetZi^Y N (n/aj/ T3 on samples match COC?C VOC Samples have zero headspace?( Y f^^'Ti/a ) SarnpT^properly preserved? ( Y N'Cn/a

NYC-WTC_000226984