NYC-WTC_000197393

NYC 9/11 Public Portal Document Anaiyucai services 4418 Pottsville Pike PSC Work Order # □ Reading. PA 19605 CHAIN OF CUSTODY 0 26S a. phone: (610)921-8833 Page i Of I fax: (610) 921 -9667 or 921 -8407 PO# Quote#

Report !D: ^^5 Company ^Kr^eTriJS. L v-- C- • Resuits Mailing Address g fZ- ANALYSIS REQUESTED' To: Zb State XZ ZIP/<?<?/O UsQ sitachments if necessaiy. Sfl co Telephoneff Please specify method requirements. Preservatives Key; tn I Name A = Ascorbic Acid W OJ Submit Company C = HCI N2 = NaS2O3 Mailing Address H=HN03 S = H2SO4 □ I Invoice city (0 To: Telephone # state Fax # ZIP 4 I = Ice Z = ZnAcetate N-N3OH X = None GfedH Cardinfo {include exp. dale) Sampled by: jy z,. Sampling Location (Specify State): 0 = Other: Due Date?*^ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) f,

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Pieservath»s (See above Key; __________ UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P^PIastic, G=Giass, A^/ur) % s SAMPLE DESCRIPTION Final Air Volumf Matrix Type Sampling Info Corttabier Veriuma (Liter, etc) H (ID must match coiilamer labels) (L ^ef-wiii) Dale Time Number of Contalriers I 2 ^/c - ‘'57cT-A?Zg/---<^ /£> cZo 3 o 'J 4 ' i- fl S L 6 7 8 Al 9 k: . I I- 10

(1) Relinquished by; Date time (2) Received by: Dale Time (3) Relinquished by; DateJ Time o (4) Received by; Date Time (5) Relinquished by: Date Time (6) Received at Lab: 'o' o co; O| Method of Delivery: UPS FED-E)C) PAS Courier Client US Mail Other co co co 4^

NYC-WTC_000197393