NYC-WTC_000207772

NYC 9/11 Public Portal Document

RSC PSC Analytical Services 4418 Pottsville Pike n PSC Work Order# Q. Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page I of / fax: (610) 921-9667 or 921-8407 PO# Quota S Name JOB ID: H J Report Company AgfcCx'tJb^ tw.-. r- Resuits Mailing Address (cq. fe-j-Tt /pr'/t fTiX , ANALYSIS REQUESTED I U9 CD To: CHy State Use atiachmerits if necessary. 01 I Please specify method requirements. Preservatives Key: tu Name A = Ascorbic Acid tn □ I Submit Company C = HCt N2 = NaS2O3 Mailing Address H = HN03 S =H2SO4 Invoice 'city CD To: Stale ZIP N ! = Ice Z = ZnAcetate Telephone # Fax # N = NaOH X = None Credit Card Into (include exp. date}

Sampled by: Due Date: Sampling location (Specify Slate):_____________ (Rush TAT requires Lab approval) $ 9 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=PlBstic, G=Glass, A^Air) vt 2 UI SAMPLE DESCRIPTION Final Air Volitm Matrix Type Sampling Info Container Volume (Liter, etc) H {ID must match container labels) (L or min) Time Date Number of Containers I /VrZrn 1 - to 7(:?< - 4"^' A - Aa u 3 f c Jc £<rc>- /iL/ cn 4 - c- 9c C - 5 4r 0. 5 Q 6 7 I ® M N 8

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o (—1 to o w I o (1) Relinquished by. , Date lime (3) Relinquished by: Dale Time o o CP co o (4) Received by: □ate Time (5) Rellnqui^by; Bl /A Dale Time '6| Recsived al Lpb: Date Time cr^ D. o (U _____ L o V) Method of Delivery: . UPS D-EX PAS Courier Client US Mail Other

NYC-WTC_000207772