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← Document results/DEP Box 38/45 JOHN STREET; Block: 78 Lot: 28 BIN: 1001199 1-5 Dutch Street
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Chain of custody form for indoor air quality survey at

Machine-extracted title · confidence 95%

Documentation tracking the collection and handling of samples during an air quality survey at the specified building.

NYC-WTC_000108401–000108573

Folder label: “45 JOHN STREET; Block: 78 Lot: 28 BIN: 1001199 1-5 Dutch Street

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Scanned page image, NYC-WTC_000108487
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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 ~" —

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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,~~•

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II Ct ain of Custody

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NYC-WTC 000108487

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NYC-WTC_000108487Source: NYC Law Department, mirrored locally

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Record documenting the transfer and custody of air samples from Building #100 at 345 South End Avenue collected on October 22, 2001.

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