Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

r’SC PSC Analytical Services 4418 Pottsville Pike PSC Work urder # 3 Cu tx

a Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page 00

o 1- of 1 rc fax: (610)921-9667 or 921-8407 PO# EEEEEEEEEE M

Pvvv--j_>i L o Vv W JOB ID: □ Report Name Company T5 Results Mailing Address ANALYSIS REQUESTED To: Pity state // /ZIP /o>O/c Use attachments if necessary. w Please specify method requirements. Preservalives Key: T) tn G CO Name A = Ascorbic Acid n G M O Submit Company C»HCI N2 = NaS2O3

H Mailing Address H = HNO3 S =H2SO4 H Invoice citi; stale ZIP I = Ice Z = ZnAcetale O To: Telephone # Fax# N = NaOH X = None no V Creriil Card Info (include exp. date) o H Sampling Location (Specify State): M Sampled by; 0 = Other: O O H O Due Date; (Rush TAT requires Lab approval) Hl S < G REPORTING REQUIREMENTS (Circle all that apply) M Hl a Full Data Package Reduced Deliverabies Package Electronic Data Deliverables Preservatives (See above Key; O M list all that apply! 23 S a H M HI UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P-Plashc, G=Glass, A-Air) G >

S o ' H s SAMPLE DESCRIPTION Final Air Volttmt (ID must niatcli container labels) (L B* »wiii) Malrix Type Date Sampling Info Time Container Volume (Liter, etc)

Number of Containers tn to 1

2 TEaE - Sji /I a I co to M TJ 3 /dP £> 1,0 rd 4 3 tc I

to 5 tn o tn o 6 co <1 O H 8 K I 9 to

I o in

(11 Reliiiqutehed Dale lime (2) Received by: Dale Time :3j Relinquished by: Date lime o T3 I (4) Received by: v7 (5) Relinquished by: Dale Time (6) Received at Lab: Date Time o Dale Time ro o co CO Method of Delivery: UPS FPD-EX 0 PAS Courier Client U3 Mail Other CO co

NYC-WTC_000175587