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
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