NYC-WTC_000221467

NYC 9/11 Public Portal Document

PSC Analytical Services 33 ■D 4418 Pottsville Pike PSC Work Order # ri Reading, PA 19605 CHAIN OF CUSTODY Woo S3 Q 01 phone: (610) 921-8833 Page I of I a fax: (610)921-9667 or 921-8407 ro PO# Quote St Q == Report Name JOB ID: UI Company ro Results Mailing Address- Lp ANALYSIS REQUESTED T5 4r~' (c yL To; State Use attachments if necessary. Telephone ff ^<5 > I Name Please specify method requirements. Preservatives Key: A = Ascorbic Acid D 05 n Submit Company C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S = H2SO4 Invoice City State ZIP .u l = lce Z = ZnAcelate To: 1 Telephone ft Fax# N = NaOH X = None Credit Card Info (include exp. date) Sampled by: J, Sampling Location (Specify Stale): 0 = Other: Due Date: ■ (Rush TAT requires Lab approval) S REPORTING REQUIREMENTS (Circle all that apply) <3 Full Data Package Reduced Deliverables Package Electronic Data Deliverables PraseivatlvBs (See above Key; list atlthat apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P=Plastlc, G=Giass, A=Air) at SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Container Volume (Liter, etc)

I (ID must match container labels) (L -or-mm) Dale Time • Number of Containers 1 otl^---- 0) 2 Q I 3 U) rd 4 I 5 Cfi 6 03 o! 03 Hi 7 <1 H' 1"^ 8 9 S o 10

o o (1) Relinquished by: Date Time (2) Received by: Dale Time (3) Relinquished by: Date Time I o o (4) Received by: Date Time (5) Relinquished by: Dale Time (6) Received at Lab: Date Time TI CO J.2)ra<5i-v' ro CO

co Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other o to

NYC-WTC_000221467