NYC-WTC_000197414

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike PSC Work Order # Q- Reading, PA 19605 CHAIN OF CUSTODY V-Cf? / f phone: (610) 921-8833 Page of fax: (610)921-9667 or 921-8407 PO# Quote #

Report Name C rJ V\ yx_______________ JOB ID; Company Results Mailing Address A VC, Avxc CD \OLtz CD ANALYSIS REQUESTED CD I To; City State /TZ/ ZIP Use attachments if necessary. Telephone# jjf Please specify method requirements. Preservatives Key: OJ tn Name A = Ascorbic Acid I □ Submit Company ' C = HCI N2 =NaS2O3

CD Mailing Address H = IINO3 S =H2SO4 Invoice City Stale ZIP I = Ice Z = ZnAcelale To; Telephone It Fax # N = NaOH X = None

I Credit Card Info (include exp. dale) Sampled by: Sampling Location (Specify Stale): O = Other: Due Date: / (Rush TAT requires Lab approval)

REPORTING REQUIREMENTS (Circle all that apply)

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservathes (See above Key: list all that apply) UST NPDES MIPP RCRA Stormwaler DEP (PWS# ) TypB (P=Plaslic, t3=Glass, A=Airj ** SAMPLE DESCRIPTION Final Air Voluini MallIX Type Sampling Info . Container Volume (Liter, etc)

(ID must malcli coninmer labels) (L er' mint Dale Time Number ol Containers

V u 2 ATA~' V to 3 Arc-AATT f /y" ____ V aid 0. 4 06 A r- - i-\ CT V

Q a. 5 6 A co 7 H n 8 I—i □ 9 s Q w ■

to o o I—i

o (1) Relinquished by: (2) Received by: Dale Time (3) Relinquished by: Dale Time I Time o o byiu co C (4) Received by: TT /Dam Time (5) Relinquished by: Dale Time (6) Received al Lab: Date Time ...^- o uo a 6' '/3 cn Method of Delivery: UPS z-fED-EX PAS Courier Client US Mail Other o t

NYC-WTC_000197414