NYC-WTC_000229408

NYC 9/11 Public Portal Document

co R5C PSC Analytical Services 4418 Pottsville Pike PSC Work Order # 0. Reading. PA 19605 phone: (610) 921-8833 CHAIN OF CUSTODY Page t of 4 fax: (610) 921-9667 or 921-8407 PO# Quote#

Report Name -( fl U vs JOB ID: m Company (0 Results Mailing Address Alic X>4.c ANALYSIS REQUESTED CD 01 To: City state 7^ ZIP Use attachments if necessary. I Telephone ^2,^6 Please specify method requirements. Preservatives Key; Name A = Ascorbic Acid 0) t I Company so □ Submit C = HCI N2 = NaS2O3 Mailing Address H = HNO3 S = H2SO4 Invoice city U3

To: Telephone # State Fax# ZIP dl I = Ice N = NaOH Z = ZnAcetate X = None Credit Card Info (include exp. date) J Sampled by: Due Date:

Full Data Package

UST NPDES Sampling Location (Specify State): (Rush TAT requires Lab approval) REPORTING REQUIREMENTS (Circle all that apply)

MIPP Reduced Deliverables Package

RCRA Stormwater Electronic Data Deliverables

DEP (PWS# ) I O = Other;

Preservatives (See above Key; list all that apply) Type (P=Plastic, G=Glass, A=Air)

SAMPLE DESCRIPTION Final Air Volumr Matrix Type Sampling Info Container Volume (Liter, etc) I (ID must match container labels) (L on mm) Date Time Number of Containers I e tre- ‘76 t\ 1 r LoigU^_____ 6 CkV- Lci,L>4 RjQO^ L) W 3 / 76 4Tc-o7<m- (Ct-w. k JS)L * 5 6 0. 7 8 9 s M 10 n □ (1) Relinquished by; ^1/ Time (2) Received by; Date Time (3) Relinquished by; Date Time 1° ’t o o (4) Received by: Dale Time (5) Relinquished by: Dale Time (6) Received al Lab:

c\) H 1—1 Method of Delivery: UPS FED-EX PAS Courier Client US Mail Other o

NYC-WTC_000229408