NYC-WTC_000228284

NYC 9/11 Public Portal Document

PSO Chain of Custody Record Sample Container information 4418 Pottsville Pike Reading, PA 19605 “ Bottle Type IT tCdS'-UI It phone: 1610) 921-8833 fax: (610) 921-9667 I G P im *—✓ ANALYTICAL SERVICES # of Containers cQ O Preserved? <Y/N| 1=> ro

ro Report Company a ti) LT Ac Tl City Ay Stale y^ ZIP

Telephone *

Nams J^Telephone I 2 Send Company ! Invoice Address /^02.0101^7 t—'

To; City State ZIP M

Sampled by: Credit Card «

______ Matrix Dale Exp. Date

Tine PAS Quote# s Type Sampled Sampled tn SAMPLE DESCRIPTION (Zomments/Hazards/ Location Details e i ■/T^^oill-gqh-Moi 1^* c 'fi»r H. n <? 2 1- ft 3 ' /^Tc-oUl -g<|K-no3 w Z RIa*A / 4 5 IVXc-ty'M Moll, A tn 6 □ (0 7 ro I-*

to tn 9 tn o H rro I'd III Special Instructions (including Data Deliverables and Turn Around Time): -J

I—i S , , Date . Time Samples Relinquished by: Samples Relinquished to: I Date I Time O lA/Adst I i c o Sample* received by:

Method ofShipmenUDelivery: LT’S ^rlLPJy^Y I Date

PAS Couricr I Time Samples Relinquished by:

Client drop oi? Other Samples Rcllnqu^ed to / I Laboratory: / /Date L?7gO Time

CO u Samples Rec'd. on Ice? ( Y Temp. Blank ______ Sample Temp._______ Notes : ro ■

Samples rec'd intac(^N ) Custody seals intact?! Y n(^) ID on samples match COC?T^^ I i VOC Samples have zero headspace?! Y N <!57aT\ Samples properly preserved? ( Y N Kal

NYC-WTC_000228284