NYC-WTC_000202414

NYC 9/11 Public Portal Document

05 RSIZ PSC Analytical Services 4418 Pottsville Pike (L Reading, PA 19605 CHAIN OF CUSTODY phone: (610) 921-8833 fax; (610) 921-9667 or 921-8407 1. A PO# Quote#

Report Name JOB ID: Company ATC. rye Lm. Results Mailing Address ANALYSIS REQUESTED CD 1 q D (qT\ PL- CD CD To: City A Slale ZIP YOrci/'G Use attachments if necessary. I Telephone# je I,£. gZgd; Please specify method requirements. Preservatives Key;

CM Name A = Ascorbic Acid cn

o I Submit Company C = HCI N2 = NaS2O3 Vlailing Address H = HNO3 S =H2SO4 co Invoice City stale ZIP Co' I = Ice Z = ZnAcetate To: Telephone # Fax # N = NaOH X= None

i Credit Card Info (include exp. date) ' -J —f" - -f— '

Sampled by; '.'aarU X'TLaTv/,-' Sampling Location (Specify Stale): O = Other:

Due Date; (Rush TAT requires Lab apprcjval) REPORTING REQUIREMENTS (Circle all that apply) ^serv^lives (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^QIaSS, A-Air)

SAMPLE DESCRIPTION Final Air Voliinit Matr ix Type Sampling Info Container Volume (Liter, etc)

(ID must match container labels) (L or: nwi) Date Time Number of Containers /caaa- G jylLj _______ ____ 1 4^/4-rr « ;l|. « 2 Z? c u 9. 3 4rc.-o22^ - 6 C‘ 4’ yftUc tn 0. 0 4 Arc -o'? 2/ A ^OC Y 5 6 7 CO 8 n "J- 9 H D to r cu □ (1) Relinquished by; Time (2) Received by; Dale Time 11(3) Relinquished by: Dale Time n □ CO (4) Received by: £ihuDate Tims (5) Relinquished by: Date Time [(5) Received al Lab;p^^^^ c- I o o 'Method of Delivery; UPS Othei^ ED-E>^ PAS Courier Client US Mail CJj

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NYC-WTC_000202414