Chain of custody and analysis request form, undated

NYC 9/11 Public Portal Document

gL EDISON o Durtiam Road 3 Edison, New Jersey OS017 CHAIN OF CUSTODY / ANALYSIS REQUEST tJ

t>> HJ Phone: (732) 549-3900 Fax: (732) 540-3670 PAGE X OF-L 00

o no Name (for report and Invoice ) Samplers NameXPrinled) SiLe/Projecl to 23

O ConiMnv / P.O.# ' stale (Location of site): NJ: Q] NY: CT Other tn "0 Ca Regulator Program; ' O CD Address . , , An»lytl« rurniround Tima / AfuiYsrs AEoniEaico (CKTER*x-aacwT^MOitATeftE<iuerrj LAB USE only nq Slsjdatil L] / / / Project No: o cn Rush Oiarges^ltiaiteed for / <1 TJ U hs ZWertij I Job No; tzi Phans. ~ ' Fax tWMkQ x> Olhet fl TV >Ai Ui □ No, of. P -I N \ Sample a> •-4 Z5 J Sample Identification Dats Time Matrix Coni. 2S Numbers CO □ W5W ID C fD -5 U Ln

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= Presarvation Used: 1 - ICE. 2 = HCI. 3 = MjSO^, 4 = UNO,. 5 = NaOH Soil; to

6 = Othar , 7 = Other Waler. I 23

U3 Special Instructions Waler Watais Filtered (Yes/No)? 23 23 Rellnqi^l^Ed by ”7/ CopJpany , / / Date/lime [Company * 25 Q 1) Geo \5 H RdWfqLiished by Company Dale/Time iReceived by Company ui

21 1 2) R 1 Relinquished by Company Dale / lime Received by Company So ! I 3) 3> o 1 O o Relinqirisaed by Ojnnpany Dale / Time Received oy Company o J? -D o • 4) 4) <=> PJ re CO Laboratory Certification-^; Naw Jersey (120205, New York (11452), Pennsylvania (68-522), Connecticut [PH-0200), Rhede Island (l32). co II co

NYC-WTC_000182115