NYC-WTC_000203532

NYC 9/11 Public Portal Document AIR SAMPLING PSC Work Order# 03 CM

4418 Pottsville Pike phone; (610) 921-8833 CHAIN OF CUSTODY Page _Jl_ of \ UJ Reading, PA 19605 fax. (610) 921 -9667 CD 2 PO » Qwte # Name

Report F........ .CbYz^ Submit Cempany BasultS 1°°*^ (tSSSCCaJi^ txe.________ Malling Addtess ~

iMaili ng Address Ulf Invoice City State ZIP stale yt// ZiP/aa/Z> To; Telephone# Fax# I IfTelephone 2^go Fax « , g7o^^ Credit Card Info (ineJude exp. date)

g COMMON MATRIX TYPES Job/Project Name: /^ / ~ J ______________ !. Badge (OVht/Tassive Moniuirj 6. Wipe (specify type) Sampler's Name(s): g 2 Tube (specify type: charcoal, silica, KAD, etc) 7 TedlarBag Sampling Location (Specily Slate)- >vZ» - yp xA H 3- Tram (fitter + tube, 2 tubes in series, etc) 8.Snniina Can Due Date (Rush results requires Lab approval): 4. RIter/CasseUe (specify PVC, MCE. OFF, etc,) 9. PUFZResin/XAD REPORTING REQUIREMENTS (Circle all that apply): <i 5. hopinger Solutions (specify components) 10, Other (list details); Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables u e I—I--------------------------------- ------------ FINAL AIR * MATRIX MEDIA SAMPLE FLOWRATES SAMPLE DESCRIPTION VOLUME SAMPLE ANALYSIS REQUESTED I (ID must match container labels) (see above list) (list catalog (specify: number) ■jiTinutes^je^ * DATE TIMES Scan Stop (speciJy units: loiciaf finaf Average V^e aitackmenls necessary. PLeate specify metiuui retjuirements. 1 2 ci^treotL / Z g> / 4 o QLl Z7/? /7/g zz o -jL C,^

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S (1) Relinquished by; Date Time (2) Received by- Date Time

" — 1. ~ " ----- (4) Received by /// /Z o 51(3) Relinquished by:

__ _4x^ Date Time Time o (-D O ------------------------------------------- ---------------——- (JI «-( .. ,, — Wl /a /o 2 Methoid of Delivery: UPS PSC Courier Client US Mail Other

NYC-WTC_000203532