NYC-WTC_000226984

NYC 9/11 Public Portal Document

WMB , tj

Chain of Custody Record Samp/e Container Information 01 □ ■ 4418 Pottsville Pike Reading, PA 19605 ' Bottle Type O phone; (610) 921-8833 fax; (610) 921-9667 ( G P IH I ANALYTIC/VL SERVICES if of Containers □ ipo # Preserved? (Y/N) l=> Nams Report Company z O ro Results Mailing Address 0)

To: TJ w Name - Telephone # n 31 Send Dept. □ Ol Invoice ^**’'''"0 Address (£ To: City ''state zip vr X [Page 2>< of .-2^ ft

0 Credil Card S Exp. Dale PAS Quote# (U

Sarnpled by: Air Vol. (L Matrix Dale Time tn SAMPLE DESCRIPTION •«wn> Type Sampled Sampled (D / Cotnments/Hazards/ Location Details T C 1 Ar^/22^^ry-^-/i o 2 ID ID 3 A 4

5 tn w 6 □ U3 7 ro 8 to tn tn 9 o 10 H Special Instructions (includinz Data Deliverables and Turn Around Time): k; I 7^ . to S ■ Samples Relinquished by: . Sample! Relinquished to: I Dale J Time O iMi I I Samples Relinqm^^d to o Samples received by: Date j Time Samples Relinquished by: i /Date I Time _ o : Laboratory; .A-^^ J 2</O / Lzo^ Method of shipment/Deiivery; UPS ZFE^^zfiX' PAS Courier Client drop off Other “ TJ CO Noles : U Samples Rec'd. oryke? I Y Temp. Blank_ Sample Temp, C5^ Samples rec'd intact^Y^ ) Custody seals intact?! Y IcTon samples match COC/i^Jw I VOC Samples have zero headspace?! Y N efiST? Samples properly preserved? ( Y N W/Q CO

NYC-WTC_000226985