NYC-WTC_000205302

NYC 9/11 Public Portal Document

SSlS AM.ftLVTOM. AIR SAMPLING PSC Work Order# pa

4418 Pottsville Pike phone; (610) 921-8833 CHAIN OF CUSTODY Page L of CS p. E (3 Reading, PA 19605 fax; (610) 921-9667 fS rj

PO# Quote # Marne

Name Company Report _ ________ —s: Submit CO Company Mailing Address - Results Mailing Address Invoice //py City st ate ZIP To­ oiy /\j state /Vy ZlP/^^/P To- Telephone #' Fax # cn cs Uj Telephone it 2 2 - Credit Card Info (iiclude ,exp. date) UD cn COMMON MATRIX TYPES Job/Project Name: /9Z2 3~- ■ CD

1. Badge (OVbJ/PaAsiveMonitDi) 1 Wipe (specify type) Sampler's Name(5): 2. Tubs (specify type:, charcoal, silica, XAD, etc) I.TedlarBag Sampling Location (Specify State): ' AJ^ 3. Traill (TUtei + tubs, 2 tubes In series, etc). ’ S.SuuiHiaCaii Due Date (Rush results requires Lab approval): 4. Filter/Casssttc (specify PVC, MCE, OFF, etc,) 9>UE'KeanZXAD ~~®0mMG“RWn®iBTlT(Circleainha?a^ 5. Impirtger Solutious (specify components) 10: Other (list details): Full Data Package Reduced Deliverabtes Pkg Etectronic Data Deliverables

FINAL AIR MATRIX MEDIA SAMPTE FLOW RATES 41: '*r‘ SAMPLE DESCRIPTION VOLUME) SAMPLE TIMES ] , ) ANALysiS KEO UESTED s o (see above (list catalog (specify: DATE (specify units; . . Use atUichments ifnecessary (ID must match contoiaer labels) list) number) minutesrele) Start Stop Initial Pinal Average Please specify method reaSiirercmti. I r ) f / - 2 n

4 5 6

o 7 H S c to 9 S Ilf O

o (1) Ftelinodisfied by: Dais ,: Time (2) Reoeiyed by: Dais t ime 5G I rn o

NO (3) Relinquishsri by: Date Time IdlTeceiyeTby^”*^ Dale / J Time (JI Oh NJ NJ ZLfitks i Oh

Method of Deliverv; UPS PSC Courier Client US Mai] Other

NYC-WTC_000205302