NYC-WTC_000207962

NYC 9/11 Public Portal Document

GJ R5C PSC Analytical Services 4418 Pottsville Pike PSC Work Order # a. Reading, PA 19605 CHAIN OF CUSTODY ___ 4 phone; (610) 921-8833 Page / of ' fax: (610) 921-9667 or 921-8407 PO» Quote H

Report Name TT JOB ID; Company r* Results Mailing Address ANALYSIS REQUESTED co co cn To; City 7TM state /V ZIP f'PDfO Use attachments if necessary. I Telephone # > j /> S V Fax# Please specify method requirements Preservatives Key: w Name A = Ascorbic Acid tn I □ . Submit Company ■ 5^ ? 6 - C = HCI N2 = NaS2O3 Mailing Address H=HNO3 S =H2SO4 CD Invoice City stale ZIP I = Ice ;2 = ZnAcetate To; Telephone # Fax# N = NaOH X = None Credit Card Info (include exp. date)

Sampled by. Ih Sampling Location (Specify State): /\ M 0 = Other. I kJ Due Date: ____ _________________________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Full Data Package Reduced Deliverables Package Electronic Data Deliverables Prsservatives (See above Key; list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P-Plastic, G-Glass, A=Air) % s SAMPLE DESCRIPTION Fi: Matrix Type Sampling Info Container Volume (Uter, etc)

H (ID must match container labels) Date Time Number of Containers

1 /}y/n - Pei} ~ 7^ 2

U 3 0) D. 4 V F tZ 5 6 o 0. 7 H D 8 I—i CO 9 s o O 10 CJ o O o (1) Relinquished by.____ -- > _ Date, Time T2)Receiv6d by Date Time (3) Relinquished by; Date time I o o co CO _____ _2£Z12/Zk (4) Received by: fOate Time (5) Relinquished by. Date Time |6) Received al Lab. V o 0. UI Cn tn Method of Delivery; UPS ^ED-EX ? PAS Courier Client US Mail Other Ui I

NYC-WTC_000207962