Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike PSCWork Order# 00 Q. Reading, PA 19505 phone:(610) 921-8833 CHAIN OF CUSTODY Page (of t fax: (610) 921-9667 or 921-8407 PO# Quote #

Report Name 21 cXv<\4-d Cr ? V\ 14 JOB ID: Company A t C- X-ifT6 ^14 L YC- ■ Results Malling Address y f- ANALYSIS REQUESTED CD CD To: City zfYgxo Use sttaCfiiTiai'iis II necessary. cn Telephone 353. g 2 ' P”* a? 35*3 > Please specify methQii requirements. t-reservatives Key: I

w cy Name A = Ascorbic Acid G CO tn Company Submit C = HCI N2 = NaS2O3 M O □ I Mailing Address Invoice city § H = HN03 S =H2SO4 H H O CO To: Telephone # State Fax# ZIP 15 I = Ice N = NaOH ;Z = ZnAcetate X = None hO Credit Card Info (include exp. date) ?0 o Sampled by. Sampling Location (Specify State):_______________ O = Other; H M Due Date; (Rush TAT requires Lab approval) O O $ H O REPORTING REQUIREMENTS (Circle all that apply) H S S a3 FullTSata Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key: list all that apply) o M V s UST NPDES |MIPP RCRA stormwater DEP (PWS# ) fyps (P=Plasbc, G=Glass, A=Air) a H M H % ?0 > s-U SAMPLE DESCRIPTION Final Air VolunK Matrix Type Sampling Info Container Volume (Liter, etc) S ' (ID must match conlaincr labels) (L-e*aB»i) Date Time Number of Containers o If oSo2> - K G\vaXx_ co M CJ /Ji oe-j Z IDTF *0^ eivoAiiz'' TJ cn Q, -O5t>3 Z iRoo - 5» 47e-o5k>3Alg: £( Si O r */U-- - o5'4 3-/112 7 O'- 3/ CuuK 6leM*(<i O CO s. 7 Q o 8 H 9 o 10 S o cy □ (1) Relinquished by: Dale Time (2) Received by: Date Time (3) Relinquished bj^ Date Time I—i o in o (4) Received by; Dale Time (5) Relinquished by: Dale Time (6) Received al Lab: I o o co «j iC. E Method of Delivery; UPS FED-EX PAS Courier Client US Mail Other co Oh Oh

NYC-WTC_000175570