NYC-WTC_000211377

NYC 9/11 Public Portal Document

PSC Analytical Services I TJ 4418 Pottsville Pike PSC Work Order # T Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page f - - t a UI

a fax: (610)921-9667 or 921-8407 ru PO# Quote # Q 4^ Report Name Company X ex SA-. r. JOB ID: UI rt V \AC M Results Mailing Address- Q TJ g. (cTC ANALYSIS REQUESTED To; Stale ZIP Uss attachments if necsssary. _______ Telephone » Please specify method requirements. Preservatives Key: TJ Name A = Ascorbic Acid th n Submit Company C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO4 Invoice city Stale ZIP Z = ZnAcetate -V I = lce To: Telephone # Fax# N = NaOH X = None Credit Card Info (include exp. date) Sampled by: Sampling Location (Specify State): 0 = Other: ex Due Date: (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) t Full Data Package Reduced Deliverables Package Electronic Data Deliverables Pmsen/aOvas (Sea above Key; BstaH that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P=Plastlc, G=G/sss, A-Air)

5 SAMPLE DESCRIPTION Final Air Volumi Matrix Type Sampling Info Container Volume (Liter, etc)

(ID must match container labels) (L ’OT^nnin) Date Time Number of Containers I cn 2 O I J CD 4 ru 5 I Q CD 6 cn H CD 7 to 8 sO 9 o 10 o Io o (1) Relinquished by: Date Time 11(2) Received by: Date Time (3) Relinquished by: Date Time to co (4) Received by Date Time ^kSlReiinquishedby- Date Time (6) Received at Lab: Dale Time U I—i J. ro co co Method of Delivery; UPS FED-EX > PAS Courier Client US Mail Other

NYC-WTC_000211377