NYC-WTC_000222458

NYC 9/11 Public Portal Document

R5D PSC Analytical Services 4418 Pottsville Pike PSC Work Order it Reading, PA 19605 phone; (610) 921-8833 CHAIN OF CUSTODY Page of - t t ( fax: (610) 921-9667 or 921-8407 r PO# Quote II ( t Report Name JOB ID: Company________ ( Results Mailing Address ANALYSIS REQUESTED T t

To: state ZIP Use attachments if necessary. Telephone# ^/'zFaxg gZS O Please specify method requirements. Preservatives Key; Name A = Ascorbic Acid I ( Submit Company G- C = HCI N2 = NaS2O3 Hairing Address H = HNO3 S = H2SO4 Invoice City To: Telephone Credit Card Info (include exp. date) Slate Fax# ZIP I l = lce N = NaOH Z = ZnAcelate X = None

Sampled by: '9/^ Sampling Location (Specify Slate): /\/ y O = Other:

Due Date: ' (Rush TAT requires Lab approval)

I Full Data Package REPORTING REQUIREMENTS (Circle all that apply) Reduced Deliverables Package Electronic Data Deliverables lI;.. Preservatives (See above Key; UsI all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic, G=Glass. A=Arl

s SAMPLE DESCRIPTION Final Air Volumr Matrix Type Sampling Info Container Volume (Liter, etc) u (ID must match container labels) (L ORWinT' Date Number of Containers

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o 10 o Io (1) Relinquished by; Time (2) Received by: Date Time (3) Relinquished by: Date Time o CO (4) Received by: Dale Time (5) Relinquished by: Date Time CO

cn co Method of Delivery. UPS ^FED-E^ PAS Courier Client US Mail Other^Z 7~ C

NYC-WTC_000222458