NYC-WTC_000222712

NYC 9/11 Public Portal Document

R5C PSC Analytical Services 4418 Pottsville Pike PSC Work Order # 3 (U (£

Reading, PA 19605 phone; (610) 921-8833 CHAIN OF CUSTODY Page a 07

□ fax: (610) 921-9667 or 921-8407 ro PO#_____________________________________ Quote#__________________________ □ Cd Report Name '\0l.vv7<jlx CugUw JOB ID: 1^/r, Cd Company /Wc T WC__________ ______________ CD Results Mailing Address V Z4 J r//erTy ■a ANALYSIS REQUESTED To: s^fe ZIP Use attachmenls if necessary. Please specify method requirements. Preservatives Key: T7 Name A = Ascorbic Acid t/7 ••P n Submit Company C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO4 Invoice City To: Telephone # stale Fax# ZIP J I = Ice Z = ZnAcetale

Credit Card Info (include exp, date) J N = NaOH X = None

Sampled by: Sampling Location (Specify State): 0 = Other: Due Date: (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Preservatives (See above Key, ' Full Data Package Reduced Deliverables Package Electronic Data Deliverables list ell that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic. G=Glass, A=fiir) 51

s LU SAMPLE DESCRIPTION Final Air Volumt Matrix Type Sampling Info Container Volume (Liter, etc)

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

1 /f-rc- -tr^t 4/r tn 7 Q I 3 //o co rd

o 4 5 6 Z/Z - ^5' 1-J-O i l/ ^^E^t^ZZZZZZZZZZ I co 07 07 H 7 K I 8 to s O (—1 9 10 o o I (1) Relinquished by: Dale Time (2l Received by: Dale Time (3) Relinquished by: Date Time o o to (4) Received by: Date Time (5) Relinquished by: Dale Time (6) Received al Lab: , Date Time J J//^d7vir y-jb-oz. co Method of Delivery: UPS FED-EX PAS Courier Client . - US Mail Other

NYC-WTC_000222712