NYC-WTC_000202145

NYC 9/11 Public Portal Document

AIK SAMPLING PSC Work Order #

U5

O, 4418 Pottsville Pike phone: (610) 921-8833 CHAIN OF CUSTODY Page y Reading, PA 19605 fax: (610) 921-9667

PO # Quote# Name Name ;TTgcx-<4fy_g Report Submit Company Company ^TC Mailing Address Results Mailing Address fT Q ~ Invoice p' City State ZIP to U) To; City AfV _________ Slate ZIP To:, Telephone# Fax #' cn Telephone# 2/Fax#------- I Credit Card Info (include sxp. date)

pj m COMMON MATRIX TYPES Job/Preject Name: I □ 1. Badge (OVM/Passive Monitor) 6. Wipe (sped I’y type) Sampler's Name(s): CD 2. Tube (.specify type: charcoal, silica, XAD, etc) 7. TedlarBag Sampling Location (Specify State): 3. Train (filter + tube, 2 tubes in series, etc) S.Sunitna Can Due Dale (Rush results requires Lab approval): 4, Fiiter/Casscite (specify PVC, MCE, OFF, etc.) 9. PUF/Resin/XAU REPORTING REQUIREMENTS (Circle all that apply): 5. Impinger Solutions (specify componenis) 10. Other (list details): Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables

FINAL AIR It MATRIX MEDIA SAMPLE FLOWRATES ANALYSIS REQUESTED s SAMPLE DESCRIPTION VOLUME SAMPLE TIMES H— (see above (list catalog (specify: DATE (specif)' units: ) Use allachinenls ifnecessury. (ID must match container labels) list) number) minutes/5f« Stop' liiitia Final Average Please specifi'melhorl requirements. I to 2

3 4

u 5 tn 0. 6

7 o 8 CL H i"^ 9 M ro 10 cu S o o (2) Received by: Date Time (1) Relinquished by: Date lime o M O 77.u*^/>vv} T qj (3) Pelinquished by; Date Time (4) Received by: Date I . / Time^ . ^1 Cn

LD Q- cn W tn Method of Deiive^: UPS PSC Courier Client US Mail Other

NYC-WTC_000202146