NYC-WTC_000223615

NYC 9/11 Public Portal Document a — | a 4478 Pottsville Pike Reading, PA 19605 phone: (610) 921-8833 | fax: (610) 921-9667 or 921-8407 PSC Analytical Services CHAIN OF CUSTODY PSC Work Order # RO20>04Z2 Page 4 of ft PO # Quote # Report Name owner Co hn JOB ID: (Q\ AD - CLEQ Rasults Comay__ATC Astocote, Dvc: —, _(eailing Address (6 ty 2ST STret foyh. fKlocr ANALYSIS REQUESTED 1a. City i VWe lad Ye rx State eS ZIP /t0/@ . q Use attachments if necessary. Telephone# 9 j9 25°2 ¥ 2736 Faxt# op 9. ¢53 K%3 6G Pliaase specify methoo requiremenis. Presarvalives Key: Name x A= Ascorbic Acid Submit (Comeary iD ww) C=HC! Nz = NaS203 Invoice Mailing Address we OE Ww H=HNO3 S =H2S04 . City Stale ZiP . 2 |= Ice Z = ZnAcelate To: Telephone # Fax # ‘a N =NaOH X= Nore Credit Card (nfo {include exp. date) z Sampled by: LW AGL? Sampling Location (Specify State): LY O = Other: Due Date: (Rush TAT requires Lab approval) S REPORTING REQUIREMENTS (Circle ail that apply) 3S J a 9 en omer ae oe ‘oe — — — tT Tarescwatives (See above Key. Full Data Package Reduced Deliverables Package Electronic Data Deliverables l \ \ \ j 1 \ { Preservatives (See above Key: list all that apply) PE Aa LO BF AE A A A A NY BS es UST NPDES MIPP RCRA Stormwater DEP (PWS # ) TT Tips (P=Plasi, G=Giass Ava | = - fe amr fo nae Fr em jo es 0? nr os mar or ct ar a Nor ee ta cr ean Se eer So aOR a OO at A Pane” at ts at mae! = SAMPLE DESCRIPTION | Final Air Volum Matrix Type Sampling Info ij r | Container Volume (Liter, etc) = (ID must match container labels) (L oxen) Date Time. r r at Number of Contaners ° 1 Arc -ySe6 -ISoH- a, [2 air NG/blee | Boo WY thors Plaza o (2 | Ae -osef-/SoM- 199 (Ao Geo _|y Min lobby e(3 Wre- oSoh -s50M- 4199 | /do ges |v Roux o 14 lave-o 504 -/foH~ Hg “|b far Black J Elank H 5 is 6 No KH 7 Ss QO Kj ym = 9 oO 10 oO © (1) Relinquished by: bey ol Date Time }{(2) Received by: Date Time (3) Retinquished by: Dale Time Ne} he (4) Received by: Date Time (5) Relinquished by: Date Time {6) ie ES, Ll Lt fo ate, Tim coal “FER EY PAS Courier Client US Mail Other NYC-WTC_000223615 cO ¥T REW *EO dsc 38d 29396-1T¢6-O19 AT