Chain of custody form header, PSC Analytical Services

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike PSC Work Order # Reading PA 19605 CHAIN OF CUSTODY phone (610)921 8833 Page i of fax (610) 921-9667 or 921 8407__________________ PO# Quote #

" JOB ID Report Name Company . 1. Results Mailing Address ANALYSIS REQUESTED ) ,a 6 JT H ( r ' / /'t Fl , To City . State ZIP /:, < Use attachments if necessary Telephone# y । j P' ? z r Fax # I 9 ■ 5 ? S. 7 (<, Please specify method requirements Preservatives Key w G Name A = Ascorbic Acid ro G Company ' /U1 M Submit C = HCI N2 = NaS2O3 O Mailing Address H = HNO3 S = H2SO4 H Invoice City state ZIP H I = Ice Z = ZnAcetate O To Telephone # Fax if N = NaOH X = None G Credit Card Info (include exp date) 73 O H Sampled by l/^/ Sampling Location (Specify State) O = Other M Due Date ~ ~ (Rush TAT requires Lab approval) r^ O O H o s REPORTING REQUIREMENTS (Circle all that apply) M Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key a O H list all that apply) 73 3 a H UST NPDES MIPP RCRA Stormwater DEP (PWS it ) Type (P^PIastic G=Ctass ‘A=Air) M > % 73 3 SAMPLE DESCRIPTION Final Air Volumf Matnx Type Sampling Info Container Volume (Uter etc)^ 3 O (ID must match container labels) (L a£.rnin) Date Time Number of Containers $ f r

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NYC-WTC_000175420