NYC 9/11 Public Portal Document
04/23/211E3 12:35 2126 93114 SCIL9B NYC ADMIT! PAGE Hsi 15
IACENVIRONMENTAI_ tic 1NSUL-rANTS 1h4C: AIR SAMPI, F LUG
ff i
!EN i j PflOJEGT NUl'l1IIER. 6 1
IE LL L L E'Ho.lCCT MANA(;f-P J ._' b.:_..
IITE COPY ( M4pJr.(,4 1;
j.~ / ( Ii~
Lt_OW crr i ,1-1cm,L.Tnf4Y
203 34111 % .. . . L J~ ///
S ORMAT16N
AMG.>! ! Hf f-.(21 'H 1tJ I Ll`n:ifIC)N (mi litary) H CV'l H . TC /t)IUMF I Ii CH;;~ F1I- a !S
D ! m cif 7/n (l) r1CLU (Vu,~
:2 n_i
SAMPLE DTh /
l
t 1 ff
H -
"
rr,~ t'
/ f
/ Já
-ice _ ~) ~r r.. 4~'~~ .. . . ~ Ir ~ ~ r. ~f ~ ~,;I . . / ~ ~~.,1• 1 ~ ..
~:`
~ . i1dCnA (L'~ tA.... ~35~.
l U
Mf~L d ~ L_L~D tf
/1CLl J
~ +;,
13°~ 7 f
J
--_`__ ^~ ~
~n r-lrLne
_ .—
LLII
LTu;la
i
lAer ( _^ r .... :.:...... . i/ /, ~ % /
SAMPLE
____Fl .~o a ___
f- I C~ BLANK
2LIII -__VTOP_____
FF
IAEi ~ ,
S§ PI_E t
V J
FIEILD 9 FIELD BLANK Fg
~
CASSET? RpTC'MTER TURNAROUND TIME TYPE
:TT
SUlTS TO
PCM (D.8 MICRON ACE) IDfJ P', HR c 1Ast2a HR (—] P(,i.-A9tTE iii H,N Na.ME,GAY r~
TEM (UAS MICRON MCE) D/1 ..
CF 1 1 afl HP•S ❑ UIIRINC per
L r1 [N`/IRON rH/r-,Gl ?? 1
LOT # CAUL [JAIL I / r1 6 HRS I.1 OTHER POST•ARAIE f A.MDIFNT [I T[ / I TIME
___ __ DATE TIME
iEIINQUISNEO 8Y (print)
99,
( ~1 `~ Gv ( q n" ^ - J
RECEIVED Br (nrintl
REUNOUISHFD BY.(nrinlj ..
- A'
t:7 r/ v
(sign)
(sign;
(3Cd l
--
3 Ø5
-
RECEIVED LAY ()rint ) (sin
ENTERED ©Y,(Drint) /
,_"_-. . . ._..
~(?PRECT_EU ElY (r rin~~
Is.ignl
lA@ NAME.
IA~31NF0>~MATIQ
— _____ :. .
IiL ..._
~FISERIA. ., QMMF N1
ANALYZE _ ( ] 1 ii N!OSI1 7dnp`R Of Yf+f ll
GATE. _i TIIAE. ! TLr..I ~'.Ft I?,', r"f1 Yi.41 y ,
aC EY' [t:.TF fFl.1 t=f 11
NYC-WTC 000132053
OCR can misread numbers and units. Confirm readings against the page image before using them.