NYC-WTC_000199069

NYC 9/11 Public Portal Document

RSC PSC Analytical Services 4418 Pottsville Pike PSC Work Order#

Reading, PA 19605 phone; (610)921-8833 CHAIN OF CUSTODY Page 1 of ( fax: (610) 921-9667 or 921-8407 PO# Quote #

Report Name JOB ID; Iq <1 Company AxcoOMiJkc Results Mailing Address kXO yQ XwC' (o^ ANALYSIS REQUESTED To; City State AZ/ ^'P /6'0/d Use attachments if necessary.

Telephone # Ji, Z-jy ^3X0^ . iS’J- Pfease specify method requirements. Preservatives Key: Name A = Ascorbic Acid Company C = HCI N2 = NaS2O3 Submit 5^ Mailing Address H = HNO3 S = H2SO4 Invoice city State ZIP I = Ice Z = ZnAcetate To: Telephone it Fax# N = NaOH X = None Credit Card Info (include exp. date) Sampled by:

Due Date:

Full Data Package

UST NPDES X Sampling Location (Specify Slate): _________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply)

MIPP Reduced Deliverables Package

RCRA Stormwater DEP Electronic Data Deliverables

(PWS# ) >1. 0 = other:

Preservatives (See above Key; list all that apply)

Type (P=Plastic. G=Glass. A-Air) 3t SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc) lU (ID must match container labels) (L or.twin) Date Time Number of Containers

1 2

3 /JLo o o -4- ero ✓ ( I 4

o 5 ~- Ar ( ( H 6 ( l"^ 7 I—i 8 s o 9 o o to I o Date Time (3) Relinquished by; o (1) Relinquished by: Dale Time (2) Received by: Date Time co o co (4) Received by: Daiir Time (5) Relinquished by: Date Time (6) Received at Lab: Time I—1 (0^ o o PAS Courier Client US Mail Other Method of Delivery; UPS ED-EX

NYC-WTC_000199069