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: C 4,tc% ~o , I 6601 Kirkville Road C r • P.O. Box 369 E. Syracuse, NY 13057 Site Name: l o '7 ry 0-✓ -0571 888-577-Labs (5227) Sampled By: Tel: (315) 4377-7252 /jrp , Project #: Fax: 315 43 S

Send Report to: C 9 /n~ C`t Invoice to: 17 fr_2 r'J<~.~ ✓;e w /y // g'o 3 S /eve , /s!Lot i

❑ Purchase order number (or) Exp Date ❑ Credit Card (type) Card #

❑ Verbal Authorization / / am Standard Turn-Around Time OR ❑ Rush: Date and Time Requested: pm

❑ Phone Results to: Phone # (s/6) — T76 — $sYy ext. n ❑ Fax Results to: Fax # (S/~) — .57 — CJO 93 ❑ Email Results to: 4

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

t1 ( o iS M H/11/0 ( 7 t ~T ~VC~ 0 3-00

t~ s ôl (6 Leal 60 37mC ors 360 I 1 t g d 1 .7 SUo Cl ?a .S Vat' . e3 . v r • F •'*r ~ Coo • _tgo•1- 6 01 . 0500 22 3T . 13 __ VC IQoP3S e $ 37 Go.B '73o0 I 1 1 0 a y $'1' V `t►,a s `I ~o 37'r~Ti=E o 5 go 2c V OC.- Al;",' c4,t/ 1S • ' o 6 SliM 7 P13 S0 . \ (oo __

F'II'r/15'vAr l (( p :$flt / r I g/o 37flc(o 300 .. iv~C

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

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

Chain of Custody Print Name I ignature Date/Time ,✓ Relinquished by: Sf /it' t &'t' '~ .~~2 ~1Z• ' /q ~/ Y.,YJ Received by LAB. Samples received after 3pm will be considered as next day's business. LAB ORIGINAL . NYC-WTC 000108490