NYC-WTC_000196873

NYC 9/11 Public Portal Document AIR SAMPLING PSC Work Order

D 4418 Pottsville Pike phone. (610) 921-8833 CHAIN OF CUSTODY .toiWLz Page I of / Id Reading, PA 19605 fax (610) 921-9667 (n <r CL po # Name Quote# Name________ Company '/Tz I Report Submit Company failing Address ' Z AVe A-Bonri zvjgL, Tv^, Results Mailing Addiess vqq fe agjTU Invoice [city________ State ZIP To: state /!// ZIP /£X>/O To; pelephone# Fax 4 Credif Card Info (include exp date)

m COMMON MATRIX TYPES Job/Project Name: /5~~/9/ 2 7^ tr> 1. Badge (OVM/Passive Monitor) 6. Wipe (specify type) Sampler's Name(s): '7'^^/^ / g 2. Tube (specify type, charcoal, silica, XAJD, etc) 7. Tedlar Bag S^^ingTocatioT{Spe^ySt5e)~2_ZZZI^Z5ZZZZZZZ L 3. Train (filter -f tube. 2 tubes in senes, etc) S Sunma Can Due Date (Rush results requires Lab approval):___________________ J 4. Fiiter/Casseite (specify PVC. MCE, OFF, etc) 9. PUF/Resin/XAD REPORTING REQUIREMENTS (Circle all that apply): <l 5 Impinger Solutions (specify components) 10 Other (list deiaiJs) Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables om _ __________ _____________________ Q_ ------------------------------------------------------------------- ------------------------ PIN AL AIR * MATRIX MEDIA SAMPLE FLOW RATES ANALYSIS REQUESTED SAMPLE DESCRIPTION VOLUME sample (see above TIMES Vse aicachments if necessary b (list catalog (specify; (Qtetsr ' DATE (specify units; (ID must match container labels) list) number) minutes, etc) Slart Stop Initial Rnsl Average Please specify method rcgiaremenis. /:^c> zz ZE iH s }

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NYC-WTC_0001 96873