NYC-WTC_000195449

NYC 9/11 Public Portal Document

315 Fullerton Avenue OVE RM THEN 1 STL CHAIN OF CUSTODY Newburgh, NY 12550 TEL (845) 562-0890 STL Hvwburch FAX (845) 562-0841 CUSTOMER NAME REPORT TYPE TURNAROUND REPORT # (Lab Use Only) 5'-^_________ ADDRESS , A?,, standardD ISRAO □ NORMAL NJ REG □ CITY, STATE, ZIP ___ yY z „ , NYASP AC bD CLPD □ QUICK SAMPCETEMP. - c y A .7/^— NAME OF CONTACT Tx ' PHONE NO. ~ OTH E R________________ _ □ VERBAL. L I PROJECT LOCATION , _ CHLjORINE‘(RESIDUAL.) *' Y ____ Matrix REvIeWEDBY: PROJECT NUMBER/PO NO. _ DW = DRINKING WATER S = SOIL O = OIL NY PUBLIC WATER SUPPLIES WW = WASTE WATER SL = SLUDGE GW = GROUND WATER SOURCE ID___________ ELRPTYPE r* o _______________ FEDERAL ID o SAMPLING & g STL# DATE / TIME AM PM O § S MATRIX CLIENT I.D. EQUESTED -S- 3“ C<^VUfc3l<U^, © 2- ( ^2 / /

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SAMPLES SUBMITTED FOB ANALYSIS WILL BE SUBJECTED TO THE STL TERMS AND CONDITIONS OF SALE (SHORT FORM) UNLESS ALTERNATE TERMS ARE AGREED IN WRITING. RELINQUJ^^^ COMPANY CQMEANY TIMI I^^S -COMPANY l^V^^Y A^oY TIME rtE^N^tSlILD 3.Y COMraijfiY COMPANY DATE TIME

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NYC-WTC_000195449