NYC-WTC_000218492

NYC 9/11 Public Portal Document

PSC Analytical Services 4418 Pottsville Pike Reading. PA 19605 CHAIN OF CUSTODY Phone:(610)921-8833 Page of fax; (610) 921-9667 or 921-8407 PO # , Quote.#

Report Name JOB ID: Company ___________________ Results Mailing Address y ' ANALYSIS REQUESTED To: Q*y State y , Use attachments if necessary. telephone Fax # Please specify method requirements. Preservatives Key; Name A = Ascorbic Acid

Submit Company f X C = HCI N2 = NaS2O3 Mailing Address Invoice Cfty 2 State X ZIP H = HNO3 l = lce S = H2SO4 Z = ZnAcelale To: Telephone # Fax# V/ N = NaOH X = None Credit Card Info (include exp. date)

Sampled by: Sampling Location (Specify State): _______ O = Other; Due Date. (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key: list aH that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P^Ptastic, G-Glass. AMir)

SAMPLE DESCRIPTION Final Air voiunn ’ (ID must match container labels) Matrix Type Sampling Info

Date Time 4 *— Container Volume (Liter, etef

Number of Containers

I ZjOC? ■)

3 /Co 3 4' 4 S 6

o 7 H 8 1^ 9 10

3o (1) Relinquished^; Time (2) Received b' Date (3) Relinquistied by: Dale Time o I o o (4) Received by: Time (5) Relinqi/slied by: fv Dale Time (6) Received at Lab: Date 1 inift to co Method of Delivery; UPS ED-1 PAS Courier Client US Mail Other to !

NYC-WTC_000218492