NYC-WTC_000222459

NYC 9/11 Public Portal Document

R5C PSC Analytical Services 4418 Pottsville Pike PSC Work Order # X TJ T

Reading, PA 19605 phone: (610) 921-8833 - _ : CHAIN OF CUSTODY Page of cc

fax; (610) 921-9667 of 921-^07 PO#________ Quole# JOB ID; s Report Name ui Company Results Mailing Address Arc CD TJ ANALYSIS REQUESTED To: City Ar state . ZIP Use attachments if necessary. Telephone # 2/2 Please specify method requirements. Preservatives Key: TJ Name A = Ascorbic Acic) CD n Submit (Company C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S = H2SO4 Invoice city State ZIP <c I = Ice Z = ZnAcetate To: Telephone # •FaxtF N = NaOH X = None Credit Card Info (include exp. date) ' .< ■ Sampled by: 4Sampling Locta'tiiab.ISpecity State): 0 = Olher; Due Date: ' / ' ■ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (CircliaiUhat apply)

Full Data Package Reduced Deliverables Package • -Bectronic Data Deliverables Preservatives (See above Key: list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic. G=Glass, A=Air) I % 2 SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc) (ID must match container labels) (I. Date Number of Containers 1 /20 .^OD tn 2 /:;2.D 1/ o 3 y^/Cf CD 4 6o(? 2z 12 I 5 Kiir. CD cn o 6 cn H o H 1

to 8

I o y 10 o I i (11 Relinquished by:_^ Time [2) Received by: Date Time (3) Relinquished by: Date Time o o o/le TJ co' (4) Received by: ' Time 5) Relinquished by: Date Time (6) Received al Lab: Dale Time co UI

Method of Delivery: UPS Z'FED-EX./ PAS Courier Client US Mail Other CO

NYC-WTC_000222459