NYC-WTC_000221475

NYC 9/11 Public Portal Document

w F’SC PSC Analytical Services 4418 Pottsville Pike 0. Reading, PA 19605 CHAIN OF CUSTODY phone; (610) 921-8833 Page t of x fax; (610) 921-9667 or 921-8407 PO# Quote #

Report Name______ ■ XOO______ Company JOB ID; I T' Results Mailing Address ANALYSIS REQUESTED co co cn To: City X. Stale ZIP ZcTyj/c? Usa attachments if necessary. I Please specify method requirements. Preservatives Key; w tn o I

U) Submit Company Name

Mailing Address Invoice city State ZIP TJj A = Ascorbic Aad C = HCI H = HNO3 l=lce N2 = NaS2O3 S = H2SO4 Z = ZnAcefats To:

Sampled by: Telephone # Credit Card Info (include exp. date) Fax#

Sampling Location (Specify State); 1 N = NaOH

0 » other: x = None

i Due Date:

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

Electronic Data Deliverables .1, Praservaftve^(S^ above ^y: Bit that apply). UST NPDES MIPP RCRA Stormwater DEP (PWS # I Type IP^lBsbc. G^GIaas,

SAMPLE DESCRIPTION Final Air Volunn Matrix Type I Sampling Info Containervolume (Uter, etc) (ID must malcli container labels) (L LU ■ irrtu) Date Time Number^ Contaners

a 1 iZ 2 o 3 w 0. 4 S ( 6 I 2 a- 7 I r " o g 9 I s 10 o w o □ Time (2) Received by; Date Time |l(3) Relinquished by: o (1) Relinquished by; Dale Date Time I o o o (4) Received by: □ate Time (5) Relinquished by: Date Time |(6) Received at Lab; „ Date Time to co c ____________ co □ n Method of Delivery: UPS EDTX PAS Courier Client US Mail Other co Ui CD

NYC-WTC_000221475