Chain of custody form, PSC Analytical Services

NYC 9/11 Public Portal Document

a PSC Analytical Services n - 4418 Pottsville Pike XX PSC Work Order « O'S u Reading, PA 19605 CHAIN OF CUSTODY rc o ui o phono: (610) 921-8833 Page of fax: (610) 921-9667 or 921-8407 PO#__________________________________ Quoteat-

Report Name bVAlrvA Xcttdi/L ■ gD\ 'O’ y " Q Company UCAtHrv '17Vl^£STTn,<?r^-o’4 , /iJc CD w Results Mailing Address CSV" ^cpTsS/ib-Te'' C_______________________ ANALYSIS REQUESTED 'B > s To: Stale 4/^ Usa itlBchments ifnacassary. Telephone # 973~ Y? Pleaaa specify method raqulraments. Preservlllvat Key: T3 Name A » Ascorbic Acid M n Company______ _ _ Submit CaHCI N2“NaS2O3 cs c X

I Invoice City To: Mailing Address

Telephone d Slaw Fax# ZIP 3^ ll = HN03 l = lca N * NaOH ' S . H28CM Z = ZnAeatata X = None u □ 0)

<» Credit Card Into (include exp. dale) o m Sampled by. (,c 2 <, Sampllne Loratton (gpacify Slate): /i<y > O mother fl- I

I. ’_ 015 TL ^ushxAT rgquires lab approval) Due Date' 3 CD 9 / REPORTING REQUIREMENTS (Circle all that apply) <• <o Full Data Package Reduced Deliverables Package Elecironio Data Deliverables , Preiei^llMt'(Sia “Z^KeiT' hit tit^tl tpptyi <2 o (O UST NPDES MIPP RCRA Stormwater DEP (PWS# ) 7t^(P^PIi3tic, G’Gtut, A‘Mr) 2 S SAMPLE DESCRIPTION Filial Ail Volunx Matrix Type Sampling Into s (ID must match coniainct labels) (L 01 min) D»te Tinw Canitinar Volume (LOtr. ate) Number ol Containers

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**2. • 0^ >9 • ■ O d -0.90 0 oa-g-t>/9- X rv ^2 a C)MOC>Z.~OV X, (0 0) 5 Zx 0) I ■si o I 6 Xs H a- -()^‘2C<>Z. -0714 IS X I—i s I 9 10 O I—i o Time Relinquishad by: date Tima o Io j|(5) Rellnqijished by. T» (eTRaceivedby; ' Data Time 65Y Tima [6) Received al Lab; Pala Tima o ro O Method of Delivery: UPS AS Courier Client US Mail Other o ■o

NYC-WTC_000182062