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234827 ATTACHMENT 3 CIBA-GEIGY NORTHWESTERN PRODUCTION WELL SAMPLING RESULTS CIB 010 0430

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234827

ATTACHMENT 3

CIBA-GEIGY NORTHWESTERN PRODUCTION WELL SAMPLING RESULTS

CIB 010 0 4 3 0

Tome River Plant

CIBA-GEIGY Corporation P.O.Box 71 Tom* River, New Jersey 08753 Telephone 201 349 6200

CIBA-GEIGY

December 15, 1987

Mr. Roman Luzecky Division of Hazardous Waste Management N.J. DEPARTMENT OF ENVIRONMENTAL PROTECTION CN-028, 401 East State Street Trenton, New Jersey 08625

RE: GROUNDWATER SUPPLY WELLS

Dear Mr. Luzecky:

Recently, you requested information about our groundwater supply w e l l s , which provide water f o r process manufacturing, steam generation, and potable use only. Cooling water i s taken from the Toms River and returned. Both water uses are included i n our water diversion permit No. 2176P. The fol l o w i n g describes the groundwater w e l l s .

• Location - There are seven deep wells (DW) (Nos. 100A, 200A, 400, 404, 502, 503, and 504) located north of manufacturing f a c i l i t i e s on our property which supply groundwater, as shown i n Figure 1.

• Depth - These wells are screened i n the lower cohansey at depths of 85 t o 95 feet as shown i n the w e l l logs (Attachment 1).

• Quality - Recently, sampling of deep wells Nos. 400, 404, 502, 503, and 504 and surface monitoring wells Nos. 146, 261, 1100, and 1101 indicate there are no v o l a t i l e organics present (Attachment 2) .

We plan t o i n s t a l l additional monitoring wells upgradient (to the north) of the deep wells as part of a comprehensive groundwater monitoring proposal being submitted under the pending Discharge t o Groundwater (DGW) ap p l i c a t i o n .

Very t r u l y yours,

Barry J. Berdahl, Ph.D. Compliance Manager

BJB:dn:WD821

cc: Mr. Guy Tomassoni, NJDEP-DWR Mr. David Zebuhr, NJDEP-CRO vr - ( r , C I B 0 1 0 0 4 3 1

K l G U K t 1 WATEgfclVERSIONS

(GROUWW* SURFACE)

SITE MAP

UMNO I

— MJRVtVM MUNOMY

• *ATE* St""*

SUM fACm /»sr0XG

PIOURE a.:

fflNUS L_l_J GQRPOWT

2-3

i •

*7'

* | T-I4-4J ! 1 1

—1

ATTACHMENT 1 PRODUCTION WELL LOGS

Screen: £o'o/*/G "jScs^^Piy.^

Cone: /G"xZ2mC£iA*r&Y7Zs&

Pun:-Type -X?/*tJL C F S h e ? I\o. P3/<5?-3 Setting Si23 c5 '* Suction j^rvc-C" Stages r&'FaJZi Basket Discharge Tubing Shafting / ^ c Tubing -e-'yvCS- Press 3. ?. c ^ ^ o *

_J_I ^

Make Volts . £ £ 0 0 Phase

GO Frame -T -JCS"

Air Line

Motor ! ~~ Type ^ Cycle GO Amp. >^ R. ?. ~LL /7!£fr Form P4k&r.

Model Serial /*M? G2>/4433

WeS Started 3 -2 -^5 / First Test <4-Q>-^l Final Test Accepted ^-2>-*S^ Gear Depth &Z'j-"

Driller: /?J?*///rt?//^£

2 a' Static Level fJVo" Prediction f f j j f Pumping Level Guarantee /G27-4iS<=. Press. <30*

Installer: <S ~g>. /^e^^z^vv^r ^* ****

LAYNE-NEW YORK CO.. INC. NSWYORK.N.Y.

WATCH SUPPLY CONTRACTOR* /

OftAWN «T VftSt C I B 010 0433

APFOVZOWT

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Upper Brg;*Z?AZ/9C/ Lower rr^.r^r^?.

R. P.: 1 x^v^

Static L:v2iiX;' Prcdr.ctlsr. «**.*s-

Started <f-z<?^z First Test /o-^z Final Test -.Tr Accented tf-^-<iz G i-unt oToo Clear Depth 9- ? Vs^ Presi. #s> **

Driiicr: r*^^ InstaEer: ^r^&^rr

/>. LAYNE-NEW Y O R K CO.. INC. ^ j s a N. J .

C I B 010 0436

7&J A*>i'KOVCC> Jrt

1 s t * * 2a'

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Screen: ^rV^v~*s*>*«~***s +Sr~**

tag Type &{//<? Shop No. 4s-f<?/ Setting Size SuctionsV^-tf *^sr^ Stages 7 Basket ^<*^v<r ^apellers &e***z£ Discharge< *5fx Vy** Zead 7~s=~<?/<3 Tsbing^" Press B.P. Shafting/i" Air Liae 7^'&*

—5 <s».-sr. Type /*t>//s»/&&9^

Cycle Amp. /?&y& z. 3> P.-&L «^<5» 3\;r3i / i s c r / c ^ i £ 3rial>s<^5>'tf see

Fizal p-jrapisg Levels '< i-c^T^- 7 - / - 5 ~ - - G^srantes ^>«» Clear 2eT-_ Press.

DrSer: ~

LAYNE-NEW Y C A X CO., i.viC. LINDEN, N. J .

WATSft SUPPLY CONTRACTORS

CIB 010 0437

D U W I I a v C ^ S ? u n a v r a w

M_A

RICJINAL OROUND t-KVSU

mm* of

COftffSE AND MEDIUM

SM1D

COME

OF CLAt

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CLAY

KSSUM * SKJY W2>'

rhPt. 40** i&'wau'Vm HAtK sua nrc visiko 16** twin «uvt ma rnc tit

Wit a'WK. UUIiat SI3U RAW.

SCRUM. IS* or 11* MM. V»nQL W. b WlllR*, 1TIEL

Pmo. V*" OSL Mtt UllWlStt SUB. r\MEL UdOGb GRAVEL: 1B.C m i 4# W l

NUMUR 53015 TYPE tXM. COLUMN ft** ib* CPU>. SHAPTINO

IMPELLERS BRtofiE

Sox 10" STA0ES 7 SETTINO 11-4 'nS .F . T U » I N C I V

BOWLS ALL IRCIIE IMP. SHAFT ft. 6 iTAUilKS SELL SOCTIOM M'^y STRAINER HVtiZ

HCAO

MAXK VOLTS WD

PHASE 3 H. P. feO FRAME Q-"iL4TPIL MOOD. Ydi SKblSTIUA UPPER BRQ. biff Kit 61

G E A R

MFC RATIO

K V Y . THRUST

MFC. RPM F U E L

STARTED S - l U - L i

F I R S T T E S T 7-VS-U»

F I N A L T E S T W U »

ACCSPTE9 1-1-Li. B. P. E L E V .

PRESS. B . P . S o " A I R U N E / O s * '

f H O T O R

TYPE K CYCLE (CO

AMP. 11 RPM 1776 N O N R E V . Nt£> S E R I A L No. 051411415

LOWER BRO. S I O M U P f t D R I V 3

MODEL S E R I A L N O . t

N O N - R E V . -

E N C I N S

M O D E L

C O N T I N U O U S H. P.

S E R I A L No.

W E I L

C L E A R D E P T H UO' a?

METHOD RBIW«£ KCTAM

G U A R . C A P . 2&a

G U A R . P R E S S , afc*

FORMATION COHASCET

DRILLER F. M\tt)B?>

DATE S T A T I C L E V .

PRODUCTION

1-lS-U. 1-1-U. 3T-1' Si.0 514

77'

L O C A T I O N S K E T C H

7d

CIB 010 0438

LAYNS-N2W Y O R K C O . . I N C - LiKSCM. N. J . W A T E R S U P P L Y C O N T R A C T O R S

TOMS *Wtt CHtVUCAL (ft., IftHl RMHt, H&l 1«A2I

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SAMD VEL

AMD

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aw

WAMI

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F1ME SAND

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20*

45'

75' 72'

93'

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32.

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M A T I W I A L

20Vl4*dxH*ijittiucxoctxnr£wiKo If*** It 4 *, V|- IMU. BUia SOEfL riK WtLDCD < I V I2'#A * • WAX lAttSBCL »Ve TK »' m \V4x 7M. >SM &AME& BBSL «f£ M&KD

SCREEN, 13V LVtf i7-auntft*-WSaillBS SEEL SttTBL HI:*

PUM, V*Ttt .< 7^.flT«fll5L SaLftATU UEUED GRAVEL. I0T1U * 3-Ui SEAL. CSCKff 4ttuTT» t S ' . O -

CJLSLC to Nvram STAOCS

SCTTINO

TUSINO

B O W L S

IMP. S H A F T

S T R A I N E R

HKAO

MAKC

VOLTS

PHASE

M. P.

F R A M E

M O D E L

U P P E R 8 M .

MPO.

R A T I O

H V Y . T H R U S T

C O L U M N

SMAPTIMO

I M P E L L E R S

S U C T I O N

P R E S S . B .P .

A I R L I N E

M O T O R

TYPE

C Y C L E

AMP.

RPM

NON R E V .

S E R I A L N O .

L O W E R B R O .

G E A R D R I V E

MOOD.

S E R I A L N O .

N O N - R E V . E N G I N E

MPO.

RPM

FUEL

STARTED M-4-71

FIRST TEST fc'H*7l FINAL TEST

ACCEPTED

B. P. ELEV.

MOOEL

C O N T I N U O U S H. P.

S E R I A L No.

W E L L

C L E A R D E P T H

METHOO KB/OSS R0TAA.Y GUAR. CAP. 4O0

GUAR.

D A T E

S T A T I C L E V .

PRODUCTION

PUMP. L E V E L

W A T E R T E M P .

f. 56-CL. FORMATION OMMStS

DRILLER A.tfoOBRE fc-12-H

IK1

441 fiW 73'

L O C A T I O N S K E T C H

msr Owr URO n MMIS

C I B 010 0439 LAYNE-NEW YORK C O . . M C - L I N D E N , N. J .

WATER S U P P L Y CONTRACTORS

TDM Rntee OfcMlOL CD. Rr'37. T&rS fcUEft., M.i. p . LIU STATS •

ATTACHMENT 2

SAMPLING RESULTS

A n a l l f t l K E M An American NuKEM Company

AnalytiKEM Inc. 28 Spnngdale Road

Cherry Hill. NJ 08003 609/751-1122 215/923-2068

September 15, 1987

Ciba-Geigy P.O. Box 71 Toms River, NJ 08754

Attention: Tom Barber

Reference: Test Report No. A14668 Project: Drinking Water

This report covers the analysis of eleven (11) aqueous samples taken by AnalytiKEM on September 2, 1987. The following analyses were requested:

V o l a t i l e Organics . EPA/NIH/NBS Mass Spectral Library Search

NJ C e r t i f i c a t i o n No. NJ 04012

Si gnature

Name Michael Shmookler, Ph.D.

T i t l e Technical Pi rector

CIB 010 0440

AnalytiKEM

Table of Contents

Page

I . Sample Designation 1

I I . Methodology 2

I I I . Laboratory Chronicle 3

IV. Analytical Results 4 - 7

V. Quality Assurance Data 8 - 9

VI. Data Package 10 - 161

CIB 010 0441

AnalytiKEM

Sample Designation

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 1

Client AnalytiKEM Date Desi gnati on Desi gnati on Matri x Sampled

Well # 400 A14668-1 Aqueous 9/2/87

Well # 404 ' A14668-2 Aqueous 9/2/87 Well # 502 - A14668-3 Aqueous 9/2/87

Well # 503 - A14668-4 Aqueous 9/2/87 Well # 504 - A14668-5 Aqueous 9/2/87

Well t 1100 A14668-6 Aqueous 9/2/87

Well # 1101 A14668-7 Aqueous 9/2/87

Well # 146 A14668-8 Aqueous 9/2/87

Well # 261 A14668-9 Aqueous 9/2/87

Field Blank A14668-10 Aqueous 9/2/87

Trip Blank A14668-11 Aqueous 9/2/87

Date Submitted to Laboratory

9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87 9/2/87

CIB 010 0442

AnalytiKEM

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 2

Methodology

V o l a t i l e s

Aqueous

. Method 624, Purgeables, Federal Reg i s t e r , V o l 49, No. 209, October 26, 1984.

C I B 010 0443

AnalytiKEM

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 3

I I I . Laboratory Chronicle

Date of Sampling 9/2/87

Date of Preservation 9/2/87

Laboratory Receiver and Date Bernadette Fini 9/2/87

Organic Analyses

V o l a t i l e Organics 9/3 - 9/4/87

Supervisor Review and Approval

CIB 010 0 4 4 4

AnalytiKEM Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 4

Analytical Results

V o l a t i l e Organics

Sample_Desi£na t i on

Constituent

Chloromethane Bromomethane Vinyl Chloride Chloroethane Methylene Chloride 1,1-Dichloroethene 1.1- Dichloroethane trans-l,2-Dichloroethene

Chloroform 1.2- Di chlor oe thane 1.1.1- Trichloroethane Carbon Tetrachloride Bromodichloromethane 1,2-Dichloropropane trans-1,3-Dichloropropene Trichloroethene Dibromochloromethane 1.1.2- Trichloroethane Benzene cis-1,3-Dichloropropene 2-Chloroethyl Vinyl Ether Bromoform Tetrachloroethene 1,1,2,2-Tetrachloroethane Toluene Chlorobenzene Ethyl Benzene Xylenes, t o t a l

Units

U - Compound was analyzed attainable detection

Method Blank 1

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

A14668-1 Well # 400

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

A14668-2 Well i 404

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

A14668-3 Well # 502

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

A14668-4 Well # 503

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

(ug/l) (ug/D

for but not detected, l i m i t f o r the sample.

(ug/l) (ug/l) (ug/l)

The number i s the minimum

A14668-5 Well # 504

10U 10U 10U 10U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 5U 10U 5U 5U 5U 5U 5U 5U 15U

(ug/l)

CIB 010 0445

c i b a -Ge i gy AnalytiKEM Test Report No. A14668 September 15, 1987 Page 5

Analytical Results (CONT'D)

Vol a t i l e Organics

Sample Designation

A14668-6 A14668-7 A14668-8 A14668-9 Method Well # Well # Well * Well #

Consti tuent Blank 1 1100 1101 146 261

Chloromethane 10U 10U 10U 10U 10U Bromomethane 10U 10U 10U 10U 10U Vinyl Chloride 10U 10U 10U 10U 10U Chloroethane 10U 10U 10U 10U 10U Methylene Chloride 5U 5U 5U 5U 5U 1,1-Di chloroethene 5U 5U 5U 5U 5U 1,1-Di chloroethane 5U 5U 5U 5U 5U trans-1,2-Di chloroethene 5U 5U 5U 5U 5U Chloroform 5U 5U 5U 5U 5U 1,2-Di chloroethane 5U 5U 5U 5U 5U 1,1,1-Trichloroethane 5U 5U 5U 5U 5U Carbon Tetrachloride 5U 5U 5U 5U 5U Bromodi chloromethane 5U 5U 5U 5U 5U 1,2-Di chloropropane 5U 5U 5U 5U 5U trans-1,3-Di chloropropene 5U 5U 5U 5U 5U Tri chloroethene 5U 5U 5U 5U 5U Di bromochloromethane 5U 5U 5U 5U 5U 1,1,2-Tri chloroethane 5U 5U 5U 5U 5U Benzene 5U 5U 5U 5U 5U ci s-1,3-Di chloropropene 5U 5U 5U 5U 5U 2-uhloroethy1 Vinyl Ether 10U 10U 10U 10U 10U Bromoform 5U 5U 5U 5U 5U Tetrachloroethene 5U 5U 5U 5U 5U 1,1,2,2-Tetrachloroethane 5U 5U 5U 5U 5U Toluene 5U 5U 5U 5U 5U Chlorobenzene 5U 5U 5U 5U 5U Ethyl Benzene 5U 5U 5U 5U 5U Xylenes, t o t a l 15U 15U 15U 15U 15U

Uni ts (ug/l) (ug/l) (ug/l) (ug/l) (ug/l)

U - Compound was analyzed for but not detected. The number is the mi niraum attainable detection l i m i t for the sample.

CIB 010 0446

Analytical Results (CONT'D)

Volatile Organics

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 6

AnalytiKEM

Sample Designation

A14668-10 A14668-11 Method Field Tri p

Consti tuent Blank 2 Blank Blank

Chloromethane 10U 10U 10U Bromomethane 10U 10U 10U Vinyl Chloride 10U 10U 10U Chloroethane 10U 10U 10U Methylene Chloride 5U 5U 5U 1,1-Dichloroethene 5U 5U 5U 1,1-Di chloroethane 5U 5U 5U trans-1,2-Di chloroethene 5U 5U 5U Chloroform 5U 5U 5U 1,2-Di chloroethane 5U 5U 5U 1,1,1-Tri chloroethane 5U 5U 5U Carbon Tetrachloride 5U 5U 5U Bromodi chloromethane 5U 5U 5U 1,2-Di chloropropane 5U 5U 5U trans-1,3-Di chloropropene 5U 5U 5U Tri chloroethene 5U 5U 5U Di bromochloromethane 5U 5U 5U 1,1,2-Tri chloroethane 5U 5U 5U Benzene 5U 5U 5U ci s-1,3-Di chloropropene 5U 5U 5U 2-Chloroethy1 Vinyl Ether 10U 10U 10U Bromoform 5U 5U 5U Tetrachloroethene 5U 5U 5U 1,1,2,2-Tetrachloroethane 5U 5U 5U Toluene 5U 5U 5U Chlorobenzene 5U 5U 5U Ethyl Benzene 5U 5U 5U Xylenes, total 15U 15U 15U

Uni ts (ug/l) (ug/l) (ug/l)

U - Compound was analyzed for but not detected. The number i s the mi attainable detection limit for the sample.

C I B ©1© 0447

AnalytiKEM

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 7

Analytical Results (CONT'D)

EPA/NIH/NBS Nontargetted Library Search

V o l a t i l e Organics

No nontargetted compounds were found i n the following samples

A14668-1 Well # 400 A14668-2 Well # 404 A14668-3 Well # 502 A14668-4 Well # 503 A14668-5 Well # 504 A14668-6 Well # 1100 A14668-7 Well # 1101 A14668-8 Well # 146 A14668-9 Well # 261 A14668-10 Field Blank A14668-11 Trip Blank

CIB 010 0448

Ciba-Geigy Test Report No. A14668 September 15, 1987 Page 8

AnalytiKEM

Quality Assurance Data

Vo la t i l e Organics

Aqueous Matrix Spike/Matrix Spike Duplicate Recovery Data

Sample Spiked A14668-7

Acceptab i l i ty Limits

>

Consti tuent

Chloromethane Bromomethane Vinyl Chloride Chloroethane Methylene Chloride 1,1-Di chloroethene 1.1- Di chloroethane rans-1,2-Di chloroethene

Chloroform 1.2- Di chloroethane 1.1.1- Tri chloroethane Carbon Tetrachloride Bromodi chloromethane 1,2-Di chloropropane trans-1,3-Di chloropropene Trichloroethene (TCE) Dibromochloromethane 1.1.2- Tr i chloroethane Benzene ci s-1,3-Di chloropropene 2-Chloroethyl Vinyl Ether Bromoform Tetrachloroethene 1,1,2,2-Tetrachloroethane Toluene Chlorobenzene Ethyl Benzene Xylenes, t o t a l

Units

Amount Recovery Max. of Spike MS MSD RPD RPD Recovery

0.25 115 108 6 69 10-201

0.25 112 97 14 27 37-151 0.25 111 97 13 37 10-177

0.25 109 98 11 25 43-143

0.25 113 102 10 16 55-139

0.25 107 98 9 34 10-204

0.25 106 97 9 22 61-131

0.25 113 104 9 24 64-125

0.25 107 99 8 25 62-133 0.25 108 102 6 17 56-137 0.25 99 96 4 19 67-127 0.25 100 95 5 46 45-140

0.25 104 98 7 17 66-123

0.25 103 98 5 18 60-133

0.25 110 104 5 20 58-108

0.25 106 100 6 58 67-130

0.25 102 97 5 25 51-132

0.25 102 97 5 18 63-126

0.25 107 99 7 16 66-130

0.25 111 108 3 19 63-124

0.25 104 101 4 78 58-130

0.25 92 92 0 37 17-152

0.25 101 94 6 20 54-133

0.25 87 88 0 31 54-129

0.25 104 98 6 14 70-122

0.25 106 101 5 15 73-124

0.25 102 96 6 129 43-144

0.25 102 96 6 42 24-147

(ug) (Z) (%) U) (Z) (X)

Recovery: 0 out of . 56 outside l i m i t s

Z RPD: 0 out of 28 outside l i m i t s

C I B 010 0449

Ciba-Gei gy Test Report No. A14668 September 15, 1987 Page 9

AnalytiKEM

Quality Assurance Data (CONT'D)

Volatile Organics

Aqueous Surrogate Recovery Data

Surrogate Z Recovery

Sample Amount Desi gnati on Added, ug 1,2-Di chloroethane-d^ Toluene-dft 4-Bromofluorobenzene

Method Blank 1 0.25 97 98 101 Method Blank 2 0.25 96 100 97 A14668-7 Spike 0.25 102 99 101 A14668-7 Spike Dup. 0.25 100 98 100 A14668-1 0.25 98 99 100 A14668-2 0.25 96 97 99 A14668-3 0.25 100 101 98 A14668-4 0.25 98 100 100 •JL14668-5 0.25 98 98 100 P&4668-6 0.25 98 98 100 A14668-7 0.25 99 107 96 A14668-8 0.25 103 108 95 A14668-9 0.25 98 104 98 A14668-10 0.25 95 100 94 A14668-11 0.25 101 101 92

Acceptabili ty Li mi ts 65-130 79-117 73-128

0 out of 45 surrogate recoveries are outside acceptability limits.

0 1 ^ 0450

A n a l y t i K E M An American NuKEM Company

AnalytiKEM Inc. 28 Springdale Road

Cherry Hill. NJ 08003 609/751-1122 215/923-2068

CHAIN OF CUSTODY RECORD

Nsme of Unit and Address

TToo J- " /^ iVet , / J J " .

Number Item Description of Samples

/ V / i f <S*O<JS &*.~\pl

z V / ' «/ 6-7 c / / * V«¥ * > " t t '

3 H / / / * */«// * S"oz. " »• ii

*/ / j '» n a

V t i / I it a ii

C V 11 4 I A J * / / * / / t f 0 »| It l \

• 7 V i* 1 i I*J< I t * / / o / I I It It

V ' • Remarks:

/ / U3c . l l * I t I I f t

Person Assuming Responsibility for Samples: Time Date

Number

Number

Relinquished by

Relinquished by:

Received by:

Received by:

Time

/SSc

Time

Date Reason for Change of Custody

Vn Date Reason for Change of Custody

Number Relinquished by: Received by: Time Date Reason of Change of Custody

Number Relinquished by: Received by: Time Dete Reason of Change of Custody

C I B 010 0451

V-•/knailftiKJEM An American NuKEM Company

w

AnalytiKEM Inc. 28 Springdale Road

Cherry Hill. NJ 08003 609/751-1122 215/923-2068

CHAIN OF CUSTODY RECORD

Nama of Unit and Address ^ . . - • C i o«- to * • 11

Number Item Description of Samples

1

• 1

3

> .

V / ' / / - T A l P H>IA»K ** " "

Remarks:

Person As: turning Responsibility for Samples: . * Time

/ T i b

Oste

rA/i7

Number'

/HI]

Relinquished by: Received by: - ^ Time Date Reason for Change of Custody

&C£.I(/<!!</

Number Relinquished by: Received by: Time Date Reason for Change of Custody

Number Relinquished by: Received by: Time Date Resson of Change of Custody

1' Number Relinquished by: Received by: Time Date Reason of Changs of Custody

C I B 0 1 0 ® 4 5 2

AHJ.t A«