NYC 9/11 Public Portal Document
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copy for your records.
The white copy will be returned with your sport Please retain pink
Galson Request For Industrial Hygiene Analysis
I
• Laboratories
eool lorkvllle Road
P.O. Box 388
Company Name:
Site Name:
ed f 16 c vt c 4 eb
I E. Syracuse. NY 13057
TeL (316) 437.7262 888.6774-abs (6227) Sampled By: ~'
Fax 316 4370671 tS .~
/~
Project #-.
tom• Til.G
Invoice to: ~ ~
Send Report to: S roc
7
__
❑ Purchase order number
(or) Exp Date
❑ Credit Card (type) Card. #
❑ Verbal Authorization
am
Standard Tum•Around Time OR ❑ Rush: Date and Time Requested: pm
phone ie (S/) g g 5" t
❑ Phone Results to:
❑ Fax Results to: Fax l (3 ) - S76 - Oo 9 3
❑ Email Results to:
Sample Medium Air Sample Analysis Method
Sample Identification Date Sampled Catalo # / Lot A Volume Iltera • Requested Reference
So 1rc t alo D s Sd C- 00
I80 /C Lr '190 37ftcg1co.8 3pQ
it Sc' 1 17 S!lc y~o 7 i.o X ss 6
pG ''`3, r •e o
• I 40 B 2
I go is 7: of ' SSo
II OI 20uL f7Wvry -7 1itcrI/?yIrir 6GC
\J
•For passive monitors please not time exposed In minutes.
Comments (Please list any known interferenoee present In sampling area:
Chats of Custody
god 500
I. . /
Print Name
t1J1G D
;.• Signature
nL iretet~ebeAT TA
Date/Time
n?'Ann
NYC-WTC 000108483
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