NYC-WTC_000192911

NYC 9/11 Public Portal Document

gage PSC Analytical Services 4418 Pottsville Pike PSC Work Order # 3 tu tt to Reading, PA 19605 CHAIN OF CUSTODY Ml a a phone: (610) 921-8833 Page of ro fax: (610)921-9667 or 921-8407 o POff Quote n (D

Report Name O, Cohtq JOB ID; w Company ar Results Mailing Address To: City 77V ZZ££ZSZZ2<_S state fx/V ZIP yc^C’/ a ANALYSIS REQUESTED Use attachments i!necessary. Telephone 0 21? I f " *7 2 Fax# Please specify method requirements. T Preservatives Key: tn n Name r A = Ascorbic Add

Submit Company V xJ c = HCI NZ = NaS2O3 Mailing Addtess Vt H = HN03 S =H25O4 Invoice citR ■ Stale ZIP

II 1 = Ice Z = ZnAcetate To: Telephone tt Fax # N = NaOH X = None Credit Card Info (include exp. dale)

Sampled by;

Due Date: Sampling Location (Specify State): ___________________________ (Rush TAT requires Lab approval) I O = Other:

REPORTING REQUIREMENTS (Circle all that apply) ' Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key, list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS tt ) Type (P=Plastic, G-Class, A-Air) % SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc) (ID must match container labels) (L w nii») Date Number of Containers tn o A7T- g.VY- - Co C I /•T o Av O / □ AfTE'- Ysl,- VOC2, /gg 4 I 3"- A /C-g ^7 - 7)1 g C z. /go irijf re

F 4 *• T/ g -A) - I/O Ci^ /go V z^^z zz I (n cn 0 (n Q H 7 P< I S

so 9 to o o (1) Relinquished by; .Date Time (2) Received by: Date Time (3) Relinquished by: Date I TJ o o co (4) Received by: Time (5) Reinquisbed by: Dale Time (6) Received al Lab— Date Time o ><5 .eT_ E'i3c- O co [\0 Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other co

NYC-WTC_000192911