NYC-WTC_000203515

NYC 9/11 Public Portal Document

CO AMAmT©AL AIR SAMHLlJNLr SES^SCES O

4418 Pottsville Pike phone: (610) 921 -8833 CHAIN OF CUSTODY Page J of J g Reading, PA 19605 fax; (610) 921-9667 #______________ Quote#___________________________________ I [Mame

Report Name _______________________ Submit : Company 4<VC- O Tv-gr ■____________ Results Mailing Address {Q PL- Invoice pity___________________ _ _______ State ZIP To. [[Telephone # Fax# To: cny//<^ <_______ state zZ/ 2iPZg<g/a Telephone # J Qo Fax# g 1 oXs ((credit Card Info (include exp. date) tn > COMMON MATRIX TYPES Job/Project Name: 1. Badge (OVM/Passivc Monitor) 6, Wipe (specify type) Sampler's NameCs): 2. Tube (specify type; charcoal, silica, XAD, etc) 7 TedlarBag Sampling Location (Specify State): > _j 3, Train (filter + tube, 2 Cubes in series, etc) S.Sununa Can Due Date (Rush results requires Lab approval): ________________ <r 4 HIter/CasseCte(specify PVC, MCE, OFF, etc.) 9. PUF/ResijiyXAD REPORTING REQUIREMENTS (Circle all that apply); 5. Impinger Solutions (specify components) 10. Other (list details): Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables 0.

FINAL AIR * MATRIX MEDIA SAMPLE FLOW RATES SAMPLE DESCRIPTION VOLUME SAMPLE ANALYSIS REQUESTED I (ID must match container labels) (see above list) (list catalog number) (specify: (ul^ minutes, etc) DATE TIMES Start Stop (specify units: Initial Rna) Average ) Use att£tcfinu?iJs ^necessary. Please specify meihod reqiuremenix. 1 Ajtajfurb Z2SZ O’J 0-X 2 0- & <?-3. "jT^SSVZ Wnl 3 ©.A 0•A UD cn 4 <9 X- tH CN (P O 5 17 rH S CD o 7 H I 8 p< cn I I 9 (_j ld 10 R " t; (2) Received by. O O o (,1 Date Time I CN o \ O pH CD (3) Relinquislied by. Date Time Time S CO /0^'J Co CD Client / 4 US Mail Method of Delivery: UPS PSC Courier Other

NYC-WTC_000203515