Chain of custody form for indoor air quality survey at

NYC 9/11 Public Portal Document

Galson • Request For Industrial Hygiene Analysis Laboratories Company Name: o/(e 6601 Kirkville Road £ zfQC.4' .4' I P.O. Box 369 E. Syracuse, NY 13057 Site Name: wCs 437-72571//52 888-577-Lab//s~~(5227) roject #: Fea/x (3331n15 Sampled By. ~~;

Send Report to: C (T i?t;h C. ' v/Ta ,.Iiyc , Invoice to: II / hu ,.. I c iPtt4 P4;. 'ei .1 NY (/203 Sfrie. /Y4l► ' ,Lsfl 1 ❑ Purchase order number (or) ❑ Credit Card (type) Card # Exp Date

1 ❑ Verbal Authorization Standard Turn-Around Time OR ❑ Rush: Date and Time Requested: / / am pm ❑ Phone Results to: Phone # () — S76 — 976 Vj ext.

0 Fax Results to: Fax # (s/6 - - yo93 ❑ Email Results to:

Sample Medium Air Sample Analysis Method Sample Identification Date Sampled Catalog # / Lot # Volume (liters)* Requested Reference

1 //so o v'-. os~0 /111013/ G - ,,3 4' G 7300 1 47io /. 3 C6 Voe. .5Soe 3 7__ _5v/1 1.SSo 1 p 3¢ / c. .. Lc4~,Q 73oo

1 / % o & rl~f?~c~x

I (1f ?I37.4

1 8'O13 ?' (f7(?/c'f ///7/c'/ Fl o/ c.,/#y FFf1ot'i

'cam 53 7r

________

~oG 5S 0 3

St7 D/5 1 1117"€Y 4-0 v/ O f j / / ii@ 53, Z feriy i _____

I ____ __ ___ ______ __

1 'For passive monitors please list time exposed in minutes.

Comments (Please list any known interferences present in sampling area):

Chain of Custody Print Name natur -t Relinquished by: ,4_'9e,. q/ r' 1 Received by LAB. 0) /O. Samples received after 3pm will be considered as next day's business. LAB ORIGINAL NYC-WTC 000108486