NYC-WTC_000208118

NYC 9/11 Public Portal Document

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Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page t of I at

ro 03 fax: (610) 921-9667 or921-8407 o PO# Quote# re Report Name CgV.3\ JOB ID; □ to Company ^3e>cM3utL. Results Mailing Address ANALYSIS REQUESTED ro To; cMy ^*3te 3^/ ZIP Use attachments if necessary. 01

Telephone# 2 T-EO Please specify method requirements. Preservatives Key; Name A - Ascorbic Acid

Submit Company C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO1 Invoice City. state ZIP I = Ice ;Z = 7 n Acetate To: Telephorre # Fax K N = NaOI I X = None Credit Card Irilo (include exp. dale)

Sampled by: oo Sampling Location (Specify State): O = Other: d Due Dale: ______________________________ (Rush TAT requires Lab approval) a 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 Stornnwater DEP (PWS tt ) Type (P^PIastic. G=Glas5, A^Air)

s SAMPLE DESCRIPTION (ID niiisi match container labels) Final Air Voliinif Matrix ’I'ypc Sampling Info Date ■fiine Container Volume (Liter, etc) Number of Containers AZ//’ tT/TT^ 1 Arc—^3/?- pg gz e if/lhL 3 4 I 7 5 ZZI2. 6 U: Q 7

H s c to I—i 9 lU S O o (1) Relinquished by: ___----- Dale Time (2) Received by: Dale Time (3) Relinquished by: Dais lime- o I (6) Relinquished by: Dale Time (6) Receivtgyat Lab: / / o (4) Received by: Dale Time Tllih; o T3 co o 00 to o Method of Delivery: UPS FED-EX PAS Courier Client US Mail other o o

NYC-WTC_000208118