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
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