NYC-WTC_000202439

NYC 9/11 Public Portal Document

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COMMON MATRIX TYPES Job/Project Name: (f) 1. Badge (OVM/Passive Monitor) 6. Wipe (specify type) Sampler's Name(s); 1 Tube (specify (ype; charcoal, silica, XAD, etc) 7. Tedlar Bag Sampling Location (Specify State): 7^ > 3. Train (filter + tube, 2 tubes in series, etc) 8.Summa Can Due Date (Rush results requires Lab approval): i <I 4. FUter/Casselte (specify PVC, MCE, OFF, eto.) 5. Impinger Solutions (specify components) 9. PUF/Resin/XAD 10. Other (sis; details): REPORTING REQUIREMENTS (Circle all that apply): Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables o co Q- FINAL AIR 4t MATRIX MEDIA VOLUME SAMPLE FLOWRATES ANALYSIS REQUESTED SAMPLE DESCRIPTION SAMPLE I ►—I {ID must match container labels) (see above list.) Gist catalog number) (specify: minutes, etc) DATE TIMES (specify units: Initial ) Final Average Use iUtachmenSs ifnecessary. Please specify method reqairefnesits. I ~^c 2 3

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NO Method of Delivery: UPS D-EX PSC Courier Clienr US Mail Other

NYC-WTC_000202440