NYC-WTC_000222691

NYC 9/11 Public Portal Document

PSE PSC Analytical Services 4418 Pottsville Pike PSC Work Order#

Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page of -I fax: (610) 921-9667 or 921-8407 PO# Quote #

Report Name ~N To Vv ~ JOB ID; Company Results Mailing Address iWc- Q CxGlte Tlwc___________ ANALYSIS REQUESTED To: State ZIP /Oo/'e) Use attachments if necessary. Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid Company C = HCI N2 = NaS2O3 Submit Mailing Address Invoice City To; Telephone # state . Fax# ZIP 4 H = HNO3 I = Ice N = NaOH S = H2SO4 Z = ZnAcetate X = None Credit Card Info (include exp. dale) 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 spply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) T^e (P=Pla'stic, G=G/ass, A=Aif). % 2 SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info container Volume (Liter, etc).

(ID must match container labels) (L cm urn) Date Time Number of Containers ; I ^77 2 3 /,jo 4 // O 5 '77777 Q 6 H K I 8 to s O 9 I—i, to O; oi 'o (1) Relinquished by: Date Time (2) Received by: Date Time (3) Relinquished by; Date Time o to (4) Received by: Date Time (5) Relinquished by: Date Time (6) Received at Lab: Date Time co J 5- Ui Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other

NYC-WTC_000222691