NYC-WTC_000229453

NYC 9/11 Public Portal Document

PSC PSC Analytical Services 4418 Pottsville Pike zn PSC Work Order # , Tl T

rd Reading, PA 19605 phone:(610)921-8833 CHAIN OF CUSTODY Page ( of ( CD o ro fax; (610) 921-9667 or 921-8407 o PO# Quote tt CD

Report Name JOB ID: to

Results Mailing AddressAv(fleg, Ass o CcciTCi T c Company CU ANALYSIS REQUESTED To: City Xc'i'A. Slate ZIP Use attachments if necessary. |Telephone#^(^^ Please specify method requirements. Preservatives Key: T3 75'3. (fl Name A = Ascorbic Acid n

Submit Company C = HCI N2 = NaS2O3 Mailing Address Invoice City a H = HNO3 S =H2SO4 Slate ZIP o I = Ice Z = ZnAcelate To; Telephone # Fax# 'it N = NaOH X = None Credit Card Info (include exp. date) I Sampled by: Sampling Location (Specify State):______________ i. 0 = Other:

Due Date: (Rush TAT requires Lab approval) s REPORTING REQUIREMENTS (Circle all that apply) ts Full Data Package Reduced Deliverables Package Electronic Data Deliverables Preservatives (See above Key: list all that apply) UST NPDES MIPP RCRA Stormwater DEP (PWS # ) Type (P=Plastk, G=Glass, A=Air) % s w SAMPLE DESCRIPTION Final Air Volume Matrix Type Sampling Info Container Volume (Liter, etc) (- (ID must inalcli container labels) (L at ii.itTy Date Time Number of Containers m I At re- J - yT/. 1^ 17 Q 2 I (D 3 ru 4 ) to 5 m 6 m n 7 I—I H l"^ s LO 9

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r o (1) Relinquished by: Date Time (2) Received by: Dale Time (3) Relinquished by: Dale Time

o o (4) Received by: Dale Time (5) Relinquished by: Dale Time (6) Received al Lab: Date Titne rj

LO '/vs- <71 Method of Delivery; UPS FED-EX PAS Courier Client US Mail Other CO

NYC-WTC_000229453