NYC-WTC_000229419

NYC 9/11 Public Portal Document

F'SC PSC Analytical Services 4418 Pottsville Pike PSC Work Order # I t

Reading, PA 19605 CHAIN OF CUSTODY [Z.OtOM (1 ( I phone; (610) 921-8833 Page 4 of J ( fax: (610) 921-9667 or 921-8407_________________ r PO# Quote # ( r Report Name \ Cb W Vk_____ JOB ID; Company Atc Aj’ifiCcft.tLn c Results Mailing Address \O(^ S' ANALYSIS REQUESTED 1 To: A/aui /tfK'A State AZ ZIP Use attachments if necessary. Telephone , 2 Please specify method requirements. Preservatives Key: Name A = Ascorbic Acid c f Company Submit C = HCI N2 = NaS2O3 Mailing Address 0 H = HN03 S =H2SO4 Invoice City state ZIP I = Ice Z = ZnAcetate To: Telephone# Fax# N = NaOH X = None Credit Card Info (include exp. dale) Sampled by: Due Date: Sampling Location (Specify State); (Rush TAT requires Lab approval) s 0 = other:

REPORTING REQUIREMENTS (Circle all that apply)

Full Data Package Reduced Deliverables Package Electronic Data Deliverables Presenratives (See above Key; list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS# ) Type (P=Plastic. G=Glass, A=Air) % SAMPLE DESCRIPTION Final Air Volumf Matrix Type Sampling Info Container Volume (Liter, etc) e 1 2 (ID must match container labels) (T. ar-i niiw) Date i Time Number of Containers 0

c I .1 srY- ____________ 0 n 4 I 5 u 6 0 a n 7 I—I H 8 2 LO 9

10 n (1) Relinquished Date Time (2) Received by; Date Time (3) Relinquished by: Date Time 1° o o (4) Received by: Date Time (5) Relinquished by: Date Time (6) Received at Lab: Date Time TJ o 2^0 'vO c LO Method of Delivery; UPS FED-EX PAS Courier Client US Mail Other O LO

NYC-WTC_000229419