NYC-WTC_000196902

NYC 9/11 Public Portal Document

cu PSC Analytical Services 4418 Pottsville Pike Q. Reading, PA 19605 CHAIN OF CUSTODY Page | of । ' phone; (610)921-8833 fax: (610) 921-9667 or 921-8407__________________ PO# Quote #

Report Name JOB ID: Company KTC- ^o rTn. hx, T Results Malling Address | ANALYSIS REQUESTED CD A ■Tf'v r- U 0) To; yp/'A. State ZIP Use attachments if necessary. I Telephone# 4^ J . & 35-3 ■ Please specify method requirements. Preservatives Key; W Name A = Ascorbic Acid 0)

o I Submit Company STs^ C = HCI N2 = NaS2O3 Malling Address H = HN03 S =H2SO4 U) Invoice ci^ State ZIP 0 0 t = lce Z = ZnAcataie To: Telephone # Fax# N = NaOH X = None Credit Card Info (include exp. dale) Sampled by: Due Date: Sampling Location (Specify State):_________________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) I 0 = Other:

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key; list allthal apply)

UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P^PtasUc, G’-Glass, A^Ait) % SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc)

e e (ID must match container labels) (L a—) Date Time Number of Containers

I /JLc, oSMt. C> 6 2 fire- 02^-1 t-x- /Ao ^00 lay l^ao-M A B u p 3 /Aa QOCj •H'allh/ftu Jjw ^«m4o5 ■7 filoHt/ 0. P' 4 A /<^/( SfnuA 5 6 in Q tn 7 tn H 8 K m I □ 9

s o w o to

(1) Relinquished by: Dale Time |)(2) Received by. Date Time (3) Relinquished by. Date Time o o o I tn o (4) Received by: Date Time 1(5) Relinquished by: Dale Time (6) Received al Lab: .n

o Ui □ (C rl_________________________________ L ----- 3— <0 Cn Method of Delivery; UPS FED-EX PAS Courier Client US Mail Olhet _______ cn

NYC-WTC_000196902