NYC-WTC_000223907

NYC 9/11 Public Portal Document rov Miiaiyiicai oervices 4418 Pottsville Pike PSC Work Order #

Reading, PA 19605 CHAIN OF CUSTODY phone: (610) 921-8833 Page l of j fax: (610) 921-9667 or 921-8407_______ PO# Quote #

Report Name JOB ID: Q .2 Company Kt-cl- CkcJS. Results Mailing Address yQ CV ANALYSIS REQUESTED To; l^ily State Use attachments if necessary. Telephone Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid

Submit Company Mailing Address s:/iY-t£- C = HCI N2 = NaS2O3 S =H2SO4 H = HNO3 Invoice City State ZIP I = Ice Z = ZnAcelate To: Telephone # Fax # N = NaOH X = None Credit Card Info (include exp. dale) Sampled by: Sampling Location (Specify State): O = Other: Dug Date: O' (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservath/es (See abov^Key; ' list an that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P^PlasBc. G=Glass, A=l^r)

SAMPLE DESCRIPTION Final Air Voliini! Matrix Type Sampling Info Confairtar Volume (Liter, etc) § (ID must match container labels) (L Giefisax.) Date Time Number of Containers 1 2 Afe - c-> i!^o ^ -.^7 ir _ tJT ^i«''r' •Mc'tt 3 if- if / O 4 //c-- e?^£i V

J 5 “7 6 1

s 9 ID S'-' o (lj Relinquished by: Dale Time (2) Received by: Date Time (3) Relinquished by: Date Time

I (4) Received by: Dale Time (5) Relinquished by: Dale Time (6) Received at Lab:^/"* . Dale Time 0-1 to //' '2'4^ 7 ■ o^ Method of Delivery: UPS FED-EX J PAS Courier Client US Mail Other

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NYC-WTC_000223907