NYC 9/11 Public Portal Document
Galson Request For Industrial Hygiene Analysis
I •
Laboratories
6601 Kirkville Road
P.O. Box 369
E. Syracuse, NY 13057
Comp Name:
Site Name: I
C6
SohILI
i
IL ttG
C o rc/ Ca r
-0571 888-577-Labs (5227)
Tel: (315) 437-7252
Fax: 315 437 Sampled By: CX(ai-( RI cti Project #:
I
Send Report to: C 14 1Z.ACOA i /faA.* . 27VC, Invoice to:
v Sfircc7'
PJauv j,ew ,,vy
I
~/'
S7r /Qfi~.O ~
❑ Purchase order number
I (or)
❑ Credit Card (type) Card # Exp Date
❑ Verbal Authorization
Standard Turn-Around Time OR ❑ Rush: Date and Time Requested: i i am
pm
0 Phone Results to: Phone # (S/6) — 576 -6g /~ ext•
•
❑ Fax Results to: Fax # (5l4 - 3_76 - C~93
❑ Email Results to:
I
Sample Medium Air Sample Analysis Method
Sample Identification Date Sampled Catalog # / Lot # Volume (liters)* Requested Reference
I goofCi1R 1I 18oI v - qo C, so0
l go1o2CA Cead- 60 7c p 7oo
I 1 go103CA-f, P f} 360 37P77 ss06
of sT
Ill '0lo C 7A0 31 / IA
III VolO L 4f$ 1= S'S'o
,.. j 1'0)06(A Ct~ 5O co?
l l $0108 c Z 3c UCi oo _
• 11110109C 36 7300
1 8o io cik if 70 'r rr - h ssV6
• it 1g cal( C R. CAIII To s
I1 4oI l aL (~ 7c 13 &-F /oc Ys03
it 0 113 UR, /krc vr 0 r t&v C97
j
I -. _____________ ____________ _____________ __________
•For passive monitors please list time exposed in minutes.
mments (Please list any known interferences present in sampling area)'.. -
I S c 1fr/ie& v
am. - S
A-0
,o% I11gDIoYcRP w0.s zero fs rl-
Chain of Custody Print Name I Signature
i"
Relinquished by: I 37 A'/4/4. t.vS/q c
Received by LAB. V
Samples received after 3pm will be considered as next day's business.
LAB ORIGINAL
NYC-WTC 000108482
OCR can misread numbers and units. Confirm readings against the page image before using them.