NYC-WTC_000226235

NYC 9/11 Public Portal Document

PSC PSC Analytical Services 4418 Pottsville Pike n PSC Work Order # Reading, PA 19605 CHAIN OF CUSTODY phone: (610) 921-8833 Page fax: (610) 921-9667 or 921-8407 PO# Quote #

Report Name JOB ID; Company Results Mailing Address ANALYSIS REQUESTED ___________ To; City Telephone # zvv 2/ state /yy~ 2^S£) * Use attachments ifnecessaiy. Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid ( I Company C = HC1 N2 = NaS2O3 Submit Mailing Address H = HNO3 S =H2SO4 Invoice City stale ZIP l = lce Z = ZnAcetate To; Telephone # Fax# N = NaOH X = None

1 Credit Card Info (include exp. dale) Sampled by: Sampling Location (Specify State): Al / 0 = Other: Oue Date: ' ~~~_7Rusr^^^requiresTab_approy^ REPORTING REQUIREMENTS (Circle all that apply) Full Data Package IReduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key; list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type tP=Plastic, G=Glass. A=Air)

5 u SAMPLE DESCRIPTION Final Air Volunit Matrix Type Sampling Info Container Volume (Liter, etc) (ID must match container labels) (L or raw) Date Number of Containers 1 c 2 2 t r 4 5 V 1/ 7 c Q 6 a c H c to (—- s s O 9 I—- o 10 o Io o (1) Relinquished Time (2) R^iv^l^: l^tft Time 11(3) Relinquished by; Date Time to co 7 wo (4) Received by; ' Date Time (5) Relinquished by; bale Time I (6) Received al Lab: Date Time cn p Ui o Client Method of Delivery; UPS FED-E^ PAS Courier US Mail Other

NYC-WTC_000226235