NYC-WTC_000223620

NYC 9/11 Public Portal Document

□3 PSC Analytical Services *0 T 4418 Pottsville Pike PSC Work Order#

Reading, PA 1S605 CHAIN OF CUSTODY phone; (610)921-8833 Page \ of a rc ____________ fax: (610) 9219S57 or 921-8407 _______________ a PO # Quota » u Name '\okWu^4>\ f c\aA Report JOB >0: A. A Company r?nJG. XWC-______________ -0 Results Mailing Address j Q Lp S ANALYSIS REQUESTED To: City State yi// ZIP fc^c^/o Use attachments if necessary. TatephoneU^^lj. O Please specify methed requirememis. •D Preser/alives Key; tfj Name A = Ascorbic Acid n Company Submit C = HCI N2 = NaS2O3 Mailing Address H = HN03 S = H2SO4 Invoice city state ZIP dr 1 = 1C8 2 = ZnAcetete To: Telephone# N = NaOH X = None Credit Card Info (include exp. date) Sampled by: Due Date; SSSSSSS^SSmESSSSSSSSSSSSSZSSSSSSSSmSSSSZSSSSSSSSSXSSSSSSSSSSSSSSS

Sampling Location (Specify Stats): (Rush TAT requires Lab approval) 5 O = Olher;

REPORTING REQUIREMENTS (Circle all that apply) o Full Data Package Reduced Deliverables Package Electronic Data Deliverables Presenatlires (See above Key: * list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Piasbs, G=t3/ass, A-Air)

5 SAMPLE DESCRIPTION final Air Votunn Matrix Type Sampling Info Container Volume (Liter, etc) £ (ID must match container labels) (L Date Time Number Of Containers cn I -fl ify/lloi- fid □ ^7c--Q ^0 t t ^£3 *-> (0 3 aI - 3 (• ■ ro 4 600 if'O 3 I to o 5 A(C^o^o‘\- 11 0) 6 cn H 'J 7

8 S o 9 I—i o tn o I o Titre (2) Received by: Date Time (3) Relinquished by: o (11 Relinquished by: Dale Date Time TJ (4) Received by: / Dale Time (5) Relinquished by; Date Time |6) Received st Lab; Date Time ru cn o Client US Mail Method of Delivery: UPS FED-EX PAS Courier Other ____________

NYC-WTC_000223620