NYC-WTC_000202143

NYC 9/11 Public Portal Document

3 4418 Pottsville Pike PSC Work Order # Reading, PA 19605 Phone:(610) 921-8833 CHAIN OF CUSTODY Page I of y '~f. ro m a fax: (610) 921-9667 or 921-8407 ro POtt 33 e?' Quotes O Name JOB ID: u Report rd Company Ol- i ’<^1 A Results Mailing Address ui /r 25’^ ANALYSIS REQUESTED Cu To: City Slate /Pp /CY Use attachments if necessary. Telephone# -g./2 Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid Submit Company Mailing Address Invoice City state ZIP I C = HCI H = HNO3 N2 = NaS2O3 S = H2SO4 1 = Ice Z = ZnAcetate To: Telephone#

Sampled by: Credit Card Info (include exp, date) . Fsxti

Sampling Location (Specify Stata): I N = NaOH

O = other: X = None

t Due Date;

Full Data Package 7 REPORTING REQUIREMENTS (Circle all that apply) Reduced Deliverables Package (Rush TAT requires Lab approval)

Electronic Data Deliverables I Preservatives (See above Key; ' list all that apply) UST NPDES MIPP RGRA Stormwater DEP (PWS# ) Type (P-Plast!C, G=Glass. A-An) 4t

§ SAMPLE DESCRIPTION Final Air Voliinif Matrix Type Sampling Info Container Volume (Liter, etc) (ID must match container labels) (L 'fm—mrrr) Date Time Pumber of Containers I /PC 2 3 4

6 7 o H H 8

c to 9

s Q to

(1) Relinquished by: / Time (2) Received by: Dale Time (3) Relinquished by: Date Time o 1^ l__ (4) Received by: rM' Time (5) Relinquished by: Date Time (6) Received at t ab: 0 ■ ’Qe-rjTz^ Time y TO T <ji :S o Method of Delivery UPS , PAS GGurier Client US Mail Other (JI

CO

NYC-WTC_000202144