NYC 9/11 Public Portal Document
report. Please retain pink copy for your records.
I The white copy will be returned with your
Gallo n Request For Industrial Hygiene Analys'i's
' Labors IIS Company Name: (A 4c o _
8001 KlrkvIlk Rood
Road
P.O. sax 3e0 81te Name: 1 SC?f . //#t.' 51~~~° ~'
' ' E. Syracuse. NY 13057 -Labs (62271 ProJoat A:
Tel: (316 437-7252 988-677 Sampled 13y. ,s
Fax: 5 437-05771
311 } / /~ invoice to:
Sertd Report to: ~l7
• Jt ~' ~r ~" —
1/!. /1'fa
1 ❑ Purchase order number
(or) Card 0
Exp Date
0 Credit Card (type)
❑ Verbal Authorization
OR ❑Rush: Date and Time Requested: / I am
Standard Turn-Around Time L Q► p► Y pm
JT7 6 _ O Ol y ext.
Phone # L6
❑ Phone Results to:
Fax M is ~W -376-
c >93 p
❑ Fax Results to:
' ❑ Email Results to:
Method
Sample Medium Air Sample Analysis
Requested Reference
Sam{eIdentlficatlon
p Date Sampled Catal 1/ Lot M Volume lllers '
j V~ 26o
0oST t IgoI
37f110E1 O1 S Lea 2 , 3Co
It_Io1 o T ti/silo
7fEioJxA RO (/ /P//4 . CSC i
tiiôlo TM u!ig/ot
1 ►to t o 111110( 'nd; C,t-iv' o E 110 C. /S—
PC S5'03
Ilig TM 1t//s4, ;s'
,4le 'c ui'
YD 57/11 Th/b 1 Ir t'4C
O
I $O /,:/o ?V L O- D
S M a /~k!% 0. Le"td 73o
8010
O S50~o
1( 110( o _Tt1 l Iis/oL 7P(E /
u )it,1,CM) _ " VoC T0/
H(W(_t_sr
I t IIv
Pc
i7tei'ctry
55p3'
cc
U_tq0111 t Fi r l
I ____________
( ► 0l 37 FO Ge/ 1] A SS0
t7coo
i3 _ HI/s ?VC....
e.
w /V J 111, / SIo l r1 t•`l
aLd&K I Gff /.r`
I 1(11)k') minutes.
For passive monitors please list time exposed in
sampling area):
Comments (Please list any known interferenoes present in
A ;~sii.a _/ ,,/,,,/z,, /D.-OD S. k,~~•
- . Si nature I Oateltlme
II Ct ain of Custody
SOd 500
r1....i.
Print Name
H3I2i •b •C bb889LS9tSL Lb:Ot tto.0Z •AON
NYC-WTC 000108487
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