Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

Sacy PSC Analytical Services 4418 Pottsville Pike PSC Work Order # I ■0

Reading, PA 19605 CHAIN OF CUSTODY ro 01 phone: (610) 921-8833 Paqs I ol / □ fax; (610) 921-9667 or 921-8407 ro

POtt Quote # o ro Report Name JOB ID: (J Company m Resuits Mailing Address ANALYSIS REQUESTED TJ . To: City ~7W stale /V 7 Fax# ZIP /o<:>/o Use attachments if necessary. Telephone# ‘^2^'S'Z^ Please specify method requirements. Preservatives Key: T a Name 03 co A = Ascorbic Acid Q n M Q Submit Company C = HCI N2 = NaS2O3

H Mailing Address H = HNO3 S =H2SO4 Invoice City H O hO To: Telephone It stale

Fax# ZIP A I = Ice N = NaOH Z = ZnAcetate

X = None bo Credit Card Info/include exp. dale) O H Sampled by: Sampling Location (Specify State): /}l V

I O = other; M a o Due Date: '_____________________________________ (Rush TAT requires Lab approval) H O H S REPORTING REQUIREMENTS (Circle all that apply) <

u Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key: O M list all that apply) bo s U H UST NPDES MIPP RCRA Stormwater DEP (PWS# M H ) Type (P-Plastic, G=Glass, A-Air) bo > 5C

s f - u SAMPLE DESCRIPTION Final Air Volunii Matrix Type Sampling Info Container Volume (Liter, etc) o (ID must nialcli container labels) (L ar ihht) Date M/r^inie Number t^f Containers

I /9)'r tiliv/oT- boo cn

w 2 I- a M hj H 3

4 boo Zz I

o to o 6 tn co cn o <1 H K I 9 M

S o IO I—i o (1) Kelinqiiishnd by: / pate Time (2) Received by: Date Time (3) Relinquished by: Dale Time o Io (4) Received by: ‘iElGL ' Dafe 1 into (5) Relinquished by: Date Time (B) Received at Lab: Dale Time no o co J Fi'CJ ro IC. co Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other VO o

NYC-WTC_000175589