NYC-WTC_000230527

NYC 9/11 Public Portal Document

RSC M;y/^^>AHfSAMPLING PSC Work Order #

U) s^swse^ CUSTODY 7 B- 4418 Pottsville Pike phone: (610) 921-8833 Page 1 of Reading, PA 19605 fax: (610) 921-9667 Quote # |Name Name Company Company /PPPP Submit Mailing Address > Mailing Address Invoice |City state ZIP to IO ci^ stale /Y^y ZIP To: Telephone# Fax# 0)

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COMMON MATRIX TYPES Fax#-------- —

Job/Project Name: [Credit Card Info (include exp. date) as

S I a I. Badge (OVM/Passive Monllvi) 6. Wipe (specify type) Sampler's Name(s): S r U3 2. Tube (specify type: charcoal, silica, XAD, etc) T.TedlarBag Sampling Location (Specify State):

I 3. Train (filter + tube, 2 tubes in series, etc) 4. Filter/Cassette (specify PVC, MCE, GPF, etc.) S.Summa Can 9. PUF/Resin/XAD Due Date (Rush results requires Lab approval): _______ ________ REPORTING REQUIREMENTS (Circle all that apply): § 7 5. Impinger Solutions (specify components) 10. Other (list details): Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables

o n MEDIA SAMPLE ft MATRIX FLOW RATES 11 § " I SAMPLE DESCRIPTION

(ID must inatch container labels) (see above list) (list catalog number) (S| minuttya? etc) SAMPLE DATE TIMES (specify units; Start Stop ) Initial Final Average ANALYSIS REQUESTED Use attachmenis if necessary. Please specify methnd reguireinents.

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tn 10 o tv (1) Relinquished by: Time (2) Received by: Date Timo NO i o / 66/7/2 Al tn (3) Relinquished by: Date Time (4) Received by; Q. (V to ---- ------------------------------------------- 1I2I& Method of Delivery: UPS PSC Courier Client US Mail other

NYC-WTC_000230527