NYC-WTC_000208231

NYC 9/11 Public Portal Document

PSC PWiAIP'lTu&PL AIR SAMPLING PSC Work Order #

\1 4418 Pottsville Pike phone: (610) 921 -8833 CHAIN OF CUSTODY 0. Reading, PA 19605 fax; (610) 921 -9667

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Report '~S3w\ ceL~v\Y\ Submit Company ( _ [[company VX~N C ______ ____________________________ __ Mailing Address riesults Mailing Address VqA' " (S ~ Invoice pty State ZIP U3 R VoZ-V U-M ZIP To: [Telephone # Fax tt CD CD I IlTelephone# QAQ * T17 '-FiFoL'F) peditCard Into (include exp. dale)

PJ VJ COAIMUN MA 1 RIX TYPES Job/Project Name:______ lA I □ 1. Badge (OVM/Passive Monitor) 6. Wipe (specify type) Sampler's Name(s): vH HT U3 2. Tube (specify type: charcoal, silica, XAD, etc) T.Tedlar Bag Sampling Location (Specify State); 3. Train (filler + tube, 2 lube.s in scries, etc) 8.Summa Can Due Date (Rush results requires Lab approval); 4. Filler/Cassette (specify PVC, MCE. OFF, etc.) 9. PIJF/Resin/XAD REPORTING REQUIREMENTS (Circle all that apply): 5, Impinger Solutions (specify components) 10. Other (list details); Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables

FINAL AIR * MATRIX MEDIA SAMPLE FLOW Rates ANALYSIS REQUESTED S SAMPLE DESCRIPTION VOLUME SAMPLE Id (list catalog (specify: TIMES (specify units; ) fc (see above DATE Use atlachnienls if necessary. (ID must match container labels) list) number) minutes, etc) Stan Stop Initial Final Average Please specify method retjuirements.

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.3 ATo - cAtM- (FLO 5^'. ID 0.7 ^0x2:. 0-7. 4 4X1. cP( I X-lXM Y\ ~ V 5 •JI X 6 7 o 8 F 41 I 9 E n 10 S 21 2 (1) Relinquished by; _ ) ,'-77. / Date / Time (2) Received by; Date Time § M Io o □ — . / . -.1—- ULlII. o -i (3) Relinquished by; Date Time (4) Received by: to --------- s Method of Delivery; I roc FED-Ea PSC Courier Client US Mail Pith nr

NYC-WTC_000208231