NYC-WTC_000214931

NYC 9/11 Public Portal Document

□ R5C PSC Analytical Services 4418 Pottsville Pike PSC Work Order # t

Reading, PA 19605 CHAIN OF CUSTODY ^0Zji>-DX<}S c C phone;(610) 921-8833 Page \ of X n fax: (610) 921-9667 or 921-8407 c PO» Quote # n

Report Name________ 3sOsNV^e-Z> CJo Vv\_____________ JOB ID; 4 Company AVC- kSSoCioJX, Tv^C^» ■z Results Mailing Address fix ----- ANAL YSIS REQUESTED To; City//^ State /// ZIP /GO/O Use attachments if necessary. -| Telephone g j . g^gv Please specify method requirements. Preservatives Key: 0 r Name -el A = Ascorbic Acid

Submit Company Tftl^ C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO4 Invoice 'city' Slate ZIP l = lce Z = ZnAcelate To: Telephone tf Fax# N=NaOH X = None . Credit Card Info (include exp. date) jSampled by: Sampling Location (Specify State): yf/X______ 0 = Other;

I ■ Due Date;

Full Data Package REPORTING REQUIREMENTS (Circle all that apply) Reduced Deliverables Package (Rush TAT requires Lab approval)

Electronic Data Deliverables I preservatives (See above Key: list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Typp (P=Plastic, G=Glass, A=Air) 9

s UJ SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Container Volume (Liter, etc) (ID must match container labels) (L or min) Date Time Number of Containers 0 I- 1 2^ c 2 Ale - a'326 17 I 0 3 -a 17~ n 4 ATc. o 1^6 ' s.3^/^- \7~ /fp^cliAsr I G 5 7 Uff /'^Pt)<7^ ) 0 Q 6 /U - V'" n 1 fi.cn> ,3' 8 9 s n 10 o (1) Relinquished by; Time (2) Received by: Dale Time (3) Relinquished by: Date Time 1° o o c (4) Received by: 'Date Time (5) Relinquished by: Date Time (6) Received at Lab: ---- \ Time Cl <. ,0 3^ Method of Delivery; UPS FED-EX^ PAS Courier Client US Mail Other o

NYC-WTC_000214931