NYC-WTC_000130106
15:8
2002
ANALYTICAL
PSC
SERVICES
1418 Pottsville Pike
phone: (610) 921-8833
Reading, PA 19605
fax: (610) 921-9667
PO #
Quota •
Bed BunthanF
AIR SAMPLING
CHAIN OF CUSTODY
PSC Work Order #
R020 9025
Page
L o1 2 nax
Report
Results
To:
Company
Mailing Address
Clly
Telephone #
State
Faxr
ZIP
Submit
Invoice
To:
SAGE
Stale
Fax
ZIP
COMMON MATRIX TYPES
. Badge (OVM/Passive Monitor)
:. Tube (specify rype: charcoal, silica, XAD, etc)
:. Train (filter + tube, 2 lubes in series, etc)
1. Filter/Casselle (specify PVC, MCE, GFF, e1c.)
•. Impinger Solutions (spccify components)
6. Wipe (specify type)
7. Tedlar Bag
8.Sammna Can
9. PUF/Resin/XAD
10. Other (list details):
SAMPLE DESCRIPTION
MATRIX
(see above
list)
MEDIA
(list catalog
number)
wipe
FINAL AIR
minutes, elc)
10.2r10a
Job/Project Name:
Sampler's Name(s):
las Cedor street
Sampling Location (Specity State):
Due Date (Rush results requires Lab approval):
REPORTING REQUIREMENTS (Circle all that apply):
Full Data Package Reduced Deliverables Pkg
Electronic Data Defiverables
MB-060266
SAMPLE
DATE
SAMPLE
TIMES
Star
scop
FLOW RATES
(specify units:
InitialFinal
Average
ANALYSIS REQUESTED
Use arlachmenis If necessary.
Please specify inelhod requirements.
91a
DesiA
1 vоcь
Nmtaosoo
(ID must match container labels)
35- D-W
F7n sie
2N -O-W
61
10
= caiti
25-D-W
72
73
24
in sttt
1) Retinquished by:
Time
(2) Racelved by:
3) Relinquished by:
Time
((4) Received by:
0/09/12
Date
,300
Time
NYC 9/11
Public Portal Document
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000130106Source: NYC Law Department, mirrored locally
EPA technical review of dioxin laboratory results identifying missing TEQ calculations and requesting proper reporting units and health-based benchmark comparisons.