Chain of custody record for City of New York samples,

NYC 9/11 Public Portal Document

■■ PSC Analytical Services ' 3 Pottsville Pike PSC Work Order # G

Reading, PA 19605 CHAIN OF CUSTODY '^yjp C

phone:(610) 921-8833 Page J of L u fax; (610) 921-9667 or 921-8407 a PO# Quote » ro Report Name 2^^ CV CoV JOB ID: fq/J y-aJ.TO a re Company Arc- Results Mailing Address 1 (p ■^s3S e cCt* Cl, _________ w rAMALYS/S REQUESTED 4k To; cily A state /J- / ZIP /ao/n !j3S 3lt3chmsnfs if necessary. TJ

Telephone # 7,7 d Ji^ ■ 13'3 ■ Please specify method requirements. Preservatives Key: w G Name A = Ascorbic Acid CO ■D G Company tn M O Submit C = HC1 N2 = NaS2O3 n Mailing Address H = HNO3 S =HZSO4 H Invoice City ~ state ZIP H I = Ice 2 = ZnAcetate O To: Telephone # Fax# N = NaOH X - None hO 03 Credit Card Info (include exp. date)

I O H Sampled by: Sampling Location (Specify State):_____________ K O = Other: M O O Due Dace: 3 (Rush TAT requires Lab approval) H o s REPORTING REQUIREMENTS (Circle all that apply) nt] M a Full Data Package : । Reduced Deliverables Package Electronic Data Deliverables PieservaUves (See above Key: O M all that apply} ?0 S a H UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic, G=Glass. A==y^) M 03 > 3 s SAMPLE DESCRIPTION Final Air Volumf Matrix Type Sampling Info Cofitalner Volume (Liter, etc) O (ID must match container labels) (L 9RWW.) Dale Time Number of Containers

to 1 3, ^77 ) m w 2 /7c - I giy.. Ta (d‘ik(/i-‘.v L«>it>tv □I z±zM M 3 h3 H > 4 co ru to 5 ____________________ o 1 o 6 co co cn O 7 tn -J H 8 K I 9 to

I o 10

(1) Relinquished by: Dale Time m^Received by: Date Time (3) Relinquished by: Dale Time o

'gl G (4) Received by: Date Time M(5) Relinquished by: Date Time (6) Received stLabT^^T^^ Date Time 13 U- W G PAS Courier Client US Mail Other co o Ui

NYC-WTC_000175590