NYC-WTC_000226968

NYC 9/11 Public Portal Document

4418 Pottsville Pike .7 PSC Work Ord^n# , , J- ro Reading, PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page i of i 00

O ro fax: (610) 921-9667 or 921-8407 □ PO# Quote # u Report Name <2/\ C b R H JOB ID: cn Company tn T3 Results Mailing Address fQj^ ANALYSIS REQUESTED To; Cily yar^ Slate yvA / ZIP Use attachments if necessary.

Jelephonetta/^, Z?ciL Please specify method requirements. Preservatives Key; T tn Name A = Ascorbic Acid n Company Submit C = HCI N2 = NaS2O3 Z) □ Mailing Address H = HNO3 S =H2SO4 A) Invoice city Stale ZIP I = Ice 2 = ZnAcetale (£ To; Telephone# Fax # .'J N = NaOH X = None ft

Credit Card Info (include exp. date) o Al Sampled by. Sampling Location (Specify Stale):____________ 0 = Other: Due Date:_________ _______________________ (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply) Full Data Package Reduced Deliverables Package Electronic Data Deliverables I Preservatives (See above Key: tn ID T

list all that apply) 0 ID UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plasbc, G=Glass. A=Air) iri

SAMPLE DESCRIPTION Final Air Volmiis Matrix Type Sampling Info Container Volume (Liter, etc) H (ID must match container labels) (L or min) Date Time Number of Containers 0) 1 ^-oXZ^-rrX- 3>xfE© l^OCi o I 2 co ro 3 to 4 tn tn .5

6 7 n 8 9 10 s n (1) Relinquished by: Dale Time (2) Received by; Date, Time (3) Relinquished by: Dale Time "0 (4) Received by; Dale Time (5) Relinquished by: Dale Time (6» ■| ime hJ o k£> Method of Delivery: UPS FED-EX J PAS Courier Client US Mail Other O

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NYC-WTC_000226968