NYC-WTC_000224749

NYC 9/11 Public Portal Document

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e. SBC PSC AnaSytscaS Seirvices 4418 Pottsville Pike PSC Work Order# a Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page t of ) fax: (610) 921-9667 or 921-8407

PO# Quota #

JOB ID: Report Company X v<r___________ U) Results Mailing Address (5 5<(^ ANALYSIS REQUESTED cn To: City State _________ ZIP / Oq f £>__________ Use attachments if necessary. I Telephone# 3 . Farit ri, ^3 C ir Please specify methoii requirements. Preservatives Key: M tn Name A = Ascorbic Acid I Company o Submit 4 C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S =H2SO4 i “ Invoice city ZIP State I = Ice Z = ZnAcetate To: Telephone it Fax# N = NaOH X = None Credit Card Info (include exp. dale) Sampling Location (Specify State):__________________ 0 = Other.

i Sampled by: x Due Date: <7 (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply)

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key: list all that apply) LIST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic, G=Glass, A=Air) % S SAMPLE DESCRIPTION Final Air Volume Mairix Type Sampling Info Container volume (Liter, etc)

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

0 1 Z^o U 2 4--^- oS'^1- To CP M 0. tl 3 /.^o » 4 4rc - oTj. 1 - /gc dA j£'

5

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H □ 7 r to OJ K I—i 9 S o W to o □ o Date I U5 (1) Relinquished by: j Date Time (2) Received by; Time (3) Relinquished by: Date Time o O o to (4) Received by: C/ Dale Time (5) Relinquished by: Date Time (6) Received at Lab: Time co c co n □ i6 :oO Cn Method of Delivery: UPS ^^FED^E^^ PAS Courier Client US Mail Other CO

NYC-WTC_000224749