Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

RSC PSC Analytical Services 4418 Pottsville Pike PSC Work Order # z 01 (£

Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY AAmh Page _Jl_ of \ a

a ro fax: (610) 921-9667 or 921-8407 PO # Quote # □ CJsVsYX______ JOB ID; r\J Report tn Company tu Results fC'TU ANALYSIS REQUESTED To: Cily x^c^z^-' State xZ -Y ZIP /OoTa Use attachments if necessary. T tn Telephone # j . 'g/? o £®lS£hl:XS2^2£2^ Please specify method requirements. Preservatives Key: tn G ro Name A = Ascorbic Acid n G ro o H Submit Company Mailing Address Hams C = HCI H = HNO3 N2 = NaS2O3 S = H2SO4 H Invoice City"' “ O state ZIP I = Ice Z = ZnAcelate To: Telephone # Fax# N = NaOH X = None ro ro Credit Card Info (indude exp. dale) o H Sampling Location (Specify Stalo):_________________ 0 = Other: ro Sampled by: o o H o Due Date: (Rush TAT requires Lab approval) H < ro S ro H I REPORTING REQUIREMENTS (Circle all that apply) Preservatives (See above Key; a Full Data Package Reduced Deliverables Package Electronic Data Deliverables o ro list all that apply) ro s a H ro H UST NPDES MIPP RCRA Stormwater DEP (PW5 # ) Type (P^PIasliC, G=Glass, A^Air) ro > S ' ?- SAMPLE DESCRIPTION Final Air Volunu Matrix Type Sampling Info Container Volume (Liter, etc) o H (ID must match container labels) (L w—miff) Date Time Number of Containers m ClA? /vtrimLA. Lg to 1 ATc. M ?I 6 <3 c □ i7 &iT if Iv • 1 I w 2 ATc^- eO do ArA- CD M h3 H 3 tT~ /O d-o 60 o AOetLi^- &1,/. Lr]e\,vf w 4 I •sp. CD to o tn o tn 6 -J co O 7

H 8 K I 9 ro

I o 10

(1) Relinquistieil by. Dale lime [2) Received by: Date Time (3) Relinquished by: Date Time o 11 I o o (4) Received by. Dale 1 line (6) Relinquished by: Date Time (6) Received al Lab: . Dale I ime tn co co Method of Delivery; UPS -^D^EX ) PAS Courier Client US Mail Other CO

NYC-WTC_000175586