NYC-WTC_000199073

NYC 9/11 Public Portal Document

I — I I 4418 Pottsville Pike n__ _PSC Work Order #

V I Reading, PA 19605 CHAIN OF CUSTODY hXC;:c;07L;q a. phone: (610) 921-8833 Page / ol I fax: (610) 921-9667 or 921-8407__________________ PO# Quote tr

Report Name ^VXtV<z-e>4 t TlX rA JOB ID: Company Results Mailing Address log <e (fcj ANALYSIS REQUESTED To: City Xe?i'^ State ZIP /^«9/6 Use aitachments if necessaiy. 0 Telephone Please specify method requirements. Preservatives Key; D n Name A = Ascorbic Add 1 Company C=HCI N2 = NaS2O3 u Submit 0 n Mailing Address H = HNO3 S = H2SO4 I Invoice Ciiy □-r State ZIP I = Ice ;7 = ZnAcelale

D To: Telephone # Fax ft N = NaOH X = None Credit Card Info (include exp. date) Sampled by: fe? iw Sampling Location (Specify State):__________________ 0 = Oilier;

Due Date: _______________________________________ (RushTATj^quiresl^b^ p ro va I) REPORTING REQUIREMENTS (Circle all that apply) § Preservatives"(See above Key: Full Data Package Reduced Deliverables Package Electronic Data Deliverables list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P=Plastic, G=Glass, A^Air)

s SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Conteirter Voluine (Liter, etc)

(ID must match container labels) (L (y. min) Date Tune Nutf^erofCanMK(s^^^^_

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(1) Relinquished by: Dale Time (2) Received by: Date Time (3) Relinquished by: Date Time o o □ Io (4) Received by: Date Time (5) Relinquished by: Date Time (6) Received at Lab: Dale Time o co o co Method of Delivery: UPS CFED-EX PAS Courier Client US Mail Other 3 Ui •) co

NYC-WTC_000199073