NYC-WTC_000221476

NYC 9/11 Public Portal Document

HdG Anaiyiicai services 4418 Pottsville Pike PSC Work Order # —

OJ Reading, PA 19605 CHAIN OF CUSTODY Q. phone;(610) 921-8833 Page , / of J fax; (610) 921-9667 or 921-8407 PO# Quote #

Report Name JOB ID; Company <, Results Mailing Address LC C _ ____ (ctef-U-- ANALYSIS REQUESTED r* To; state yy// ziP Use attachments if necessary. CO co Telephone U q | Please specify method requirements. Preservatives Key: tn I

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o cn I Submit Name Company Mailing Address Invoice City state ZIP 1 -V A = Ascorbic Acid C = HC1 H = HNO3 l = lce N2 = NaS2O3 S =H2SO4 Z = ZnAcetale co To: Telephone # Fax# N = NaOH X = None Credit Card Into (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 all that apply) I UST NPDES MiPP RCRA Stormwater DEP (PWS# ) Type (P-Plastic, G=Glass, A^^Air) st

s Ll! SAMPLE DESCRIPTION Final Air Volumi Matrix Type Sampling Info ConteIrjerVolume (Liter, etc) H (ID must match container labels) (L UI lIltTTi Date Time Number of Containers

I 1/ 2

□ 4 Ui 0. .5 G 7 15 8 n CD in y QO 10 Lxj □ £n (1) Relinquished Dale Time (2) Received by: Date Time (3) Relinquished by; Date Time □ o (4) Received by: Date Time (5) Relinquished by: Dale Time (6) Received 1° O OJ O c □ Method of Delivery: UPS PAS Courier Client US Mail Other co CD

NYC-WTC_000221476