Chain of custody form for environmental samples, Feb 2002

NYC 9/11 Public Portal Document

nj nj ^SC PSC Analytical Services 4418 Pottsville Pike PSC^IVork 9j;der

a. Reading, PA 19605 CHAIN OF CUSTODY KO AOUoUtSX phone; (610) 921-8833 Page of ( ___________ (ax: (610) 921-9667 or 921-8407 ________ PO #___________________________________ Quote g___________________________

Report Nams hm, JOB ID; Company ________________ Results Mailing Address ANALYSIS REQUESTED C' ID To: /\i&3} ZVy______ Z/CU/A? Use attachments if necessary. tfl Telephoneg T,F^x It 2^ / Fiease specify ineihod requirements. Preservalives Key: Cu CD Mame A = Ascorbic Acid a nj CJJ or Company Q □ Submit C = HCI N2 = NaS2O3 PI o (D Invoice Mailing Address § II = HNO3 S =H2SO4 A City stale ZIP I = Ice <Z = ZiiAcelale I A o To: Telephone ft Fax If N = NaOH X = Hone rtj Credit Card Info {include exp. date) Id § w Sampled I Sampling Localion (Specify Stale): /TV'_______ 0 = other: H c p] Due Date: ' (Rush TAT requires Lab approval) O O H O L REPORTING REQUIREMENTS (Circle all that apply) H S < p] ng H dJ cn Full Data Package Reduced Deliverables Package Electronic Data Deliverables Presarvalives (See above Key; I a list all that apply) o p] UST NPDES MIPP RCRA Stormwater DEP (PWS # p) a s H Id ) Type iP=Pl3Stic. G-Glass, A-Air) p] H 0 3t JO > +J SAMPLE DESCRIPTION Final Air Volunif Matrix Type Sampling Info Container Volume ILiter, etc) S ' E (ID must match container labels) (L oi uiu4- Dale Time Number of Conteiners o m I c a: ? 2 2,-41 >-1 W U p] cn 3 - '1 - Sj t h3 Q. 4 H 5 ro o 6 o a. co tn 7 O in 8 H w 9 o

I—i IO w so a (1) ^linquished by: n *• lime (2) Received by: Dale lime (3) Relinquished by: Date lime ■ o nJ o I (4) Received by: Time (5) Rcl;iu|iiished by: Date Time (6) Received al Lab; Dale I iiiie o L o It) - ZlziilvL E CO Method of Delivery; UPS Cn-Fxy PAS Courier Client US Mail Other EO

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NYC-WTC_000175662