NYC-WTC_000197619

NYC 9/11 Public Portal Document ’ . I

R5CZ PSC Analytical Services 4418 Pottsville Pike _ PSC Work Order # 0. ! Reading, PA 19605 phone; (610) 921-8833 CHAIN OF CUSTODY Page / of / fax; (610) 921-9667 or 921-8407 PO# Quote#

Report Name JOB ID: Company ACC r* Results Mailing Address CD ANALYSIS REQUESTED CD To: City /yy Slate AV ZIP Use attachments if necessary. CD I Telephone# 2/2 Fax# Please specify method requirements. Preservatives Key:

OJ Name A = Ascorbic Acid cn Company I Submit Cl C^HCI N2 = NaS2O3 o Mailing Address H = HNO3 S =H2SO4 CO Invoice City Slate ZIP I = Ice Z = ZnAcelate To: Telephone it Fax# ’J 5 N = NaOH X = None Credit Card Info (include exp. date)

Sampled by: Due Date; ' /tdjnyZf ' Sampling Location (Specify State): /VV (Rush TAT requires Lab approval^ I' O = other:

REPORTING REQUIREMENTS (Circle all that apply) Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key; list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic, G^GIass, A-Air)

5 SAMPLE DESCRIPTION Final Air Volume Sampling Info Container Volume (Uler, etc) Matrix Type (ID must molcli container labels) (L sr min). Dale Time Number of Containers 1 2 7^^ \> 7

3 u cn 4 0. 5 6 Q 0. 7

H K W

W 9

So III CM o □ I,. Date, Time (2) Received by: Dale Time (3) Relinquished by: Dale Time o I o □ (4) Received by; ' Date Time (5) Relinquished by: Dale Time (6) Received at Lab; Time co o c □ Oh co Method of Delivery; UPS ED-EX PAS Courier Client US Mail Other co -.J

NYC-WTC_000197619