NYC-WTC_000197411

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page I of I

fax; (610) 921-9667 or 921-8407_________________ ( PO# Quote # = Report Cd? Vt»\ •JOB ’D: £ Company AVc- r/rtT ___________________ Results Mailing Address iPLF ANALYSIS REQUESTED To: City state /y/y________ ZIP Z<gP/'fc______ Use attachments if necessary Telephone#^/ Please specify method requirements. Preservatives Key: c t Name A = Ascorbic Acid

Submit Company C-HCl N2=NaS203 Mailing Address H = HNO3 S = H2SO4 Invoice City stale ZIP I = Ice 2 = ZnAcetate To: Telephone # Fax# N = NaOH X = None

I Credit Card Info (Include exp. dale) ' ■ —' — — ;g-eg=g=a8-. r- . =-.7— ' , - a Sampled by: Sampling Location (Specify State); 0 = Other

Due Date: (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply)

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservath/es (See above Key: list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P^PIastic. G=Glass, A=Air)

UJ SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Container Volume (Liter, etc)

(ID must match container labels) (L afaWaP Dale Time Number of Containers L

c 2 & t. 3 4 Al /J>O O ^.cSJtS

i7 SEi' h

t.

6 Q H H l'^ 8 9

I 10

o (1) Relinquished by: Dale Time (2) Received by: Date Time (3) Relinquished by: Date Time Io T o (4) Received by: Dale Time (5) Relinquished by: Date Time (6) Received at Lab: □ate Time co o kD Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other NO CO

NYC-WTC_000197411