NYC-WTC_000196519

NYC 9/11 Public Portal Document

PSC Analytical Services 3 Qi 4418 Pottsville Pike - PSC Workprder# 3 Reading, PA 19605 phone;(610) 921-8833 CHAIN OF CUSTODY Page j. of -I CD

□ fax: (610) 921-9667 or 921-8407 ro PO# Quote# □ u Report Name XtYVAJb^ f A.V lA_____________ JOB ID: Company Q Results Mailing Address /(J A ‘ ANALYSIS REQUESTED ■75 tog- g To: City /t:i>'3< Staig A/y ZIP fOOfO Use attachments if necessary. Telephone Ptease specify method lequirenients. Preservatives Key: T Name A = Ascorbic Acid tn n Submit Company 5 C = HCI N2 = NaS2O3 □3 Mailing Address 5'' H = HNO3 S = H2SO4 3 Invoice City Slate ZIP 41 I = lce Z = ZnAcetate To: Telephone # Fax# N = NaOH X = None (£ f+ Credit Card Info (include exp. date) □

r Sampled by: kiMp/ 'Tiyi vi'd Sampling Location (Specify State): /\f*V O = Other: 41 Due Date; _ _____________________________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) tn ID Preservatives (See above Key; 3 Full Data Package Reduced Deliverables Package Electronic Data Deliverables < list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic, G-Glass, A=Air) n ID w SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Container Volume (Liter, etc) I (ID must match container labels) Date Time Number of Containers & 1 ATc~o305-j?j^fI- Sj a/'r 775/J m * 2 o & to 3 [/)R- gj ffd r< 4 JIU ru 4 AR- AkkXr&f((AH4 „ Id o » 5 /}rc.- o3d5-47» A- tn tn a I H re <e 6

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to s O 8 9 o o 10 I o o (1) Relinquished by: , , Date Time (2) Received by: Date Time (3) Relinquished by: Date Time co o iV cn (6) Received al L^: ~ ■75 (4) Received by: Date Time (5) Relinquished by: Dale Time co cr^ to ----- Zpkiub ro Method of Delivery; UPS FED-EX PAS Courier Client US Mail other

NYC-WTC_000196519