37
3Y
PSC
PSC Analytical Services
4418 Pottsville Pike
Reading, PA 19605
phone: (610) 921-8833
fax: (610) 921-9667 or 921-8407
Quote#
22019
PSC Work Order #
CHAIN OF CUSTODY
Page 5of
Report
Results
To:
Submit
Invoice
To:
PO #
Name
Fred
BirKhardt.
Company
ATC HisoCiates _nc.
Maling Adross 104 C 25S tres.a
Telephone #
Name
Company
Mailing Address
Cily
Telephone #
SAME
ZIP
Fax#
Credit Card Info (include exp. date)
JOBID: 125 Cedar Street
ZIP 10010
ANALYSIS REQUESTED
Use attachments if necessary.
Please specify method requirements.
Preservalives Key:
A = Ascorbic Acid
C= HCI
H= HNO3
1=Ice
N= NaOH
N2 = NaS203
S = H2S04
Z= ZnAcetate
X= None
Sampled by:
Due Date:
Full Data Package
Sampling Location (Specify State):
(Rush TAT requires Lab approval)
REPORTING REQUIREMENTS (Circle all that apply)
Reduced Deliverables Package
Electronic Data Deliverables
O = Other: .
UST
NPDES
MIPP
RCRA
Stormwater
SAMPLE DESCRIPTION
(ID must match container labels)
95-L-W
DEP (PWS#
Final Air Yoluma
Matrix Type
(1-05-1714)
Sampling Info
wife
Date
9/12
Time
Preservatives (Sée abóve Key: "
list all that apply)
Resttf
с9.Q
45,547
+ 9N-L-W
85-L=W
=H
15808
(1) Relinquished by:
09/13
Method of Delivery:
UPS
Date
Time
Ви то
FED-EX
|(2) Received by:
Date
Time
(3) Relinquished by:
Date
Time
(5) Relinquished by:
Date
Time
)(6) Received at Lab:
Date
Time
PAS Courier
Client
US Mail
Other
NYC-WTC 000097212
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000097212Source: NYC Law Department, mirrored locally