NYC-WTC_000221477

NYC 9/11 Public Portal Document

rovz Kfiuiyuvcii oei VI 4418 Pottsville Pike PSC Work Order,# co Reading, PA 19605 phone; (610) 921-8833 CHAIN OF CUSTODY Page 0. i of I fayt. (610) 921-9667 or 921-8407 PO# Quote »

Report Name JOB ID: iq 1.5 SI, Oj q Company Ajf o tkTJj-v 2 ________________________ Results Mailing Address j Q '/A ANALYSIS REQUESTED r- To: CilyX/^ State ZIP /Cypf O Use attachments if necessary. (D CD Telephones^ 0 Please specify method requirements. Preservatives Key; 01 Name

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Submit Company *5 a A = Ascorbic Acid C = HCI N2 = NaS2O3 0) Mailing Address H = HN03 S =H2SO4 □ I Invoice City Slate ZIP V l = tce Z = ZnAcelate k CO To: Telephone # TaxH N = NaOH X = None Credit Card Info {include exp. date) =s=:3:==ss:s3s=E^s=:s=^==is:ssz=z3SS^=::s * Sampled by. ' Sampling Location (Specify Stale):____________ _ 0 = 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 bit that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) i Type (P=Plastic, G^GIess, A=Air)

2 UJ SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc)

(ID must match container labels) (L Date Time Number of Containers

I fSf/a 2 .1

U 4 U) S 0. 6 7 8 01 n -t 9 H m It) C □ CO ,

w (1) Relinquished by: Dale Time ;2) Received by; Dale Time (3) Relinquished by: Date lime n □ o (4) Received by: Dale Time (5) Relinquished by: Date Time (6) Received at Lab: t> 1° PJ O !

c Method of Delivery: UPS FED-EX^ PAS Courier Client US Mail Other □ n

NYC-WTC_000221477