NYC 9111 Public Portal Document
Request For Industrial tiygtene naiysts
Galson
Laboratories Company Name: p yr o
9801 KlrkvNla Road a
P.O. Box 389 Site Name: SO (c
E. Syracuse, NY 13057
..1 Tet'. (315) 437-7252 888-577-Labs (5227) Sampled 8y: CAries gkA Project '
Fax: 315 437-0571
Send Report to: I Z, A Cc.- t' &tti 2VC Invoice to:
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❑ Purchase order number
I Card a P Date
❑ Credit Card (type)
' 0 Verbal Authorization
am
Standard Turn-Around Time OR ❑ Rush: Date and Time Requested: r I pm
Q ~/ ext.
' 0 Phone Results to: Phone e (S/6) — 576 QVI
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❑ Fax Results to: Fax e - - C'9
❑ Email Results to:.
Sample Medium Air Sample Analysis
Method
P Identification
Sample Date Sampled
P Catalog y / Lot C Volume (liters)' Requested Reference
I it gp o Cñ-t
Cad. 360
q0
37ic p 7300
C✓ sov
dlo C
ofo___ 3 A x~~ rr06
'7 3' ":.ms I `rte of c
f I I X01 C
' 1I Slolo -C/h C $ F fors SS'
fl 11oJO&C A-le. S~ ; r-
' 11120109 o Eve 00
11i 10 C O? 30
Ill 8 O 1O. CrL it
5Uc /Pi4(I 370 F ,o s 6
• __ ___
IM) .'3" T0I
gOf C
' I t 1011-' L 17C B ( f c; .~s
o IIkK 6 'A(yd1M '1k97
I ____ __ -. ______ __
For passive monitors please list time exposed In minutes.
comments(Please list any known interferences present In sampling area): r
)fltt&) d )f
o n k ! gD D t .,~,I.pt~ •~.
I ~l d&( c v n
Chain of Custody
f Print Name I Signature Date/lime
Relinquished by: ~ ,1/ q it/d WSAi 11f1q/0, l95
Received by LAB.
Samples received after 3pm will be conataerea as next aay-s oue,ness.
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NYC-WTC 000108481
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