NYC-WTC_000226990

NYC 9/11 Public Portal Document

5 Chain of Custody Record Sample Container Informstion 4418 Pottsville Pike Reading, PA 19605 ““ Bottle tvpB Q. phone; (610) 921-8833 fax; (610) 921-9667 i G P IH 1 ANALYTICAL SERVICES # of Containers !po # Nama Preserved? (Y/N) I Report Company Me. .Jhc Results Mailing Addipss-^^ (elk.fU

P' To; CD .A/f CD cn (V Name Telephone # 1 D) o Dept, I »—I Send CD I Invoice Address State ZIP To: City V) Credit Card # Exp. Date tu PAS Quote# U Sampled by: Air Vol. (L Matris Dale time > or min) Type Sampled Sampled L SAMPLE DESCRIPTION Z' Comments/Hazards/ Location Details I QJ cn ~ Urg>g7gQ-/7y-' ^ii ^{b t<ii i/it'k 7r>i tivsr Id 0 2 /rc-oTeiy-TTy- V/t /izA jf'U-v u 330 * 3 Arc - oioi^ - y ~ 3'? 7 Sh'U'k 4

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9 o ID . H Q. T Special Instructions (including Data Deliverables and Turn Around Time); I So .•n □ I .Samples relinquished to Time Samples Relinquished by: Samples Relinquished to: Date I Time I—i o Shipper or courier by: I S' o □ Samples received by; Time Samples Relinquished by: Samples RclinjMished f-o / / i D»te Io ’J} - .1°“ I I Laboratory: W'- o Method of shipment/Deiivery: UPS ^pJEiD-EX,.-" PAS Courier Client drop oir. Other' CO C Samples Rec'd. on Ice? ( Y N^n^ Temp. Blank Notes: CD «! Sample Temp. co co co Samples rec'd intac^JV N I Custody seals intact?! Y N(^) VOC Samples have zero headspace?! Y N ) ID on samples match COC^Y/N 1 Samples properly preserved? I Y I

NYC-WTC_000226991