Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike PSC Work Order #

Reading, PA 19605 CHAIN OF CUSTODY pp phone; (610) 921-8833 Page 1 of 1 fax; (610) 921-9667 or 921-8407 po # Quote #

Report Name A.... JOB ID: o J- y > Company A;TTz rA-. r. AY ZA ./ Results Mailing AddressC, \ Y M ,.;- . i f'i (V H jc - ANALYSIS REQUESTED To; Stale A- 2iF ZzTz. / '■ use aitachrnenis if necessary. Telephone # f A Y > -y A A Z . ? V..- T- i V ( Please specify method requirements. .'Preservatives Kay: co Name G A = Ascorbic Acid CO M Submit Company /}(\4 i 0 = HCI N2 = NaS2O3 O Mailing Address H = HNO3 S =H2SO4 H invoice City State ZIP l = lce Z = ZnAcetate H O To: Telephone tt Fax# N = NaOH X = None h3 Credit Card Info (include exp. date) 23 A O Sampled by: z- z. ; y . ,-.- .Sarripling Location (Specify State): O = other: H M Due Date: (Rush TAT requires Lab approval) O o H o "reporting requirements (Circle all that apply) s nq Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preseryaiives (Bee above Key; u list all that apply) O 23 a S UST NPDES MIPP RCRA Stormwater DEP (PAST ) Type (P=Plastic, G=Glass, A-Air) M 23 SAMPLE DESCRIPTION Fural Air Volume Matrix Type Sariiplirig Into Container Volume (Liter, etc) S (ID iinist iniilclr coiitaiiiei labels) (L iH—tmn ) Date Tune Number of Containers O / y. >■ - c/ I . / / A' to I / CO M i G H J I N ’r' ■ <' z Y •

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NO M S O ,1) Relinquished by: ,, Dale 1 line (2) Received by: Date Time (3) Relinquished by: Date Time o Y- o Time Io iT) Received by: Dale 7 ime (5) 77elinquished by: Dale Time (6) Received at Lab: Date y/> A-1 '/v-V o co co ^iethod of Delivery: UPS . EED-EX PAS Courier Client US Mail Other

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NYC-WTC_000175585