NYC-WTC_000223162

NYC 9/11 Public Portal Document

RSIZ PSC Analytical Services 4418 Pottsville Pike ,Q / TSC Work Order # Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page t of fax: (610) 921-9667 or 921-8407 PO# Quote #

Report Name JOB ID; R i JIS' J 7- Company A-~vc- X>«g. Results Mailing Address ANALYSIS REQUESTED K / lA To: City state /^Z Use attachments if necessary. Telephone # . ?$ ? . 1? 2-^ R 7^3. 85 Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid

Submit Company 5/?/tAfS> C = HCl N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO4 Invoice city stale ZIP I = Ice Z = Zn Acetate To: Telephone# Fam. It N = NaOR X = None Credit Card Info (include exp. date) Sampled by. 4/y^ ^TgA/2rr//Sampling Location (Specify State): O = Other: Due Date:_____________________________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Electronic Data Deliverables Preservatives (See above Key: ' Full Data Package Reduced Deliverables Package list alt that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) rype (P=Plas1ic. G-Glass. A=Air)

SAMPLE DESCRIPTION Final Air Volume Matrix Type i£ Sampling info Container Volume (Liter, etc)

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

/o Je .X 2 09- 3ei - /^JLc 3 4 47cl - /a J o -^-£21. 5 -^-5 O’ r *

6 A/c crip U o Q H 7 ZSZ tCco--^ c/t

r to 8 y jjc. ____, I__________

S' O lO o o (1) Relinquished by: Dale Time (2) Received by: Date Time (3) Relinquished by. Date 1 ime I o o (4) Received by: Date Time (5) Relinquished by: Date Time (6) Received at Lab: ^Date Tirne CO .5-rc-t CO

CO Method of Delivery. UPS PAS Courier Client US Mail Other CTt Oh

NYC-WTC_000223162