NYC-WTC_000223617

NYC 9/11 Public Portal Document

PSC Analytical Services U 4418 Pottsville Pike £L Reading, PA 19605 CHAIN OF CUSTODY phone; (610) 921-8833 Page 1 of [ fax; (610) 921-9667 or 921-8407 PO# Quote#

Report Name fJai ________ ’D: Company ^daaaO^oJb-. ___________________ r- (0 Results ANALYSIS REQUESTED ID £33 To: City/Zge^ yl/z ZIP Us3 attachments if necessary. I Teiephone»gg(;^ g2.go Fax# 3 ■ gJ Please specify method requirements. Preservatives Key; ru Name .A = Ascorbic Ac’d 0) □ I Submit Company ’is. C = HC! N2 = NaS2O3

cc Mailing Address invoice city To; Telephone it stale

Credit Card Info (include exp. date) Fax# ZIP 4 H = HN03 l = lce N = NaOH S = H2SO4 Z = ZnAcetate X = None

I Sampled by: Sampling Location (^eclfy 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 PreservstivBs (See above Key; listen that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (F^PIa^ic, G=G/ass, A-AIr) 53: SAMPLE DESCRIPTION Final Air Volumt Malrix Type Sampling Info Container Volume (Liter, etc)

I (ID must match container labels) Dale Time Number of Containers » 1 ) 2 #Z^ -g>5'Z7 - /JoA- /vl Co jg 3 7- 4 4 aS’J.7- X ' « f

5 Q H 6 1^ 0. 7 I« 8 o W 9 (-> o o to 1° ,w 'o a o (1) Relinquished Date Time (2) Received by; □ata Time (3) Relinquished by; Dale Time rxo tn '.C □ (4) Received by; Dats Time (5) Relinquished by; Date Time (B) Received at Lab; _ Date Time Time Ui c co □ to T PAS Courier Client US Mail Method of Delivery: UPS D-EX Other

NYC-WTC_000223617