Chain of custody form for ambient asbestos air sampling at

NYC 9/11 Public Portal Document 030106535 (Iem ahera) CHAIN OF CUSTODY DOCUMENT JCB J.C. Broderick & Associates Bill To: J.C. Broderick & Associates 101•4 Colin Drive, Holbrook, NY 11741 Accounts Payable Expected Date of Completion: (0-18-0) Laboratory: 631-419-0913 • Fax: 631-584-3395 101•4 Colin Drive, Holbrook, NY 11741 Fiual uEMu Project Name: 69 MurraySt ProjectManager Kevin Kortlaug Sampler (Signatre): LyuShneuskeif Project Location: 69 Murray St. N.Y Samplers Name (Print): 4goz Lushneuskir Client Name: 69 Murray St Project Number •6 HR X12 HR []24 HR •48 HR D72 HR •4 DAY []5 DAY •6-10 DAY SAMPLE INFO Project Phase A=Air)B=Buik W=Water I=Wipe *Time (min.)→ *L/min→ Liters Analysis Analysis Date Sample ID Date Tyре Sample Location / Description Lab # 10/18/01 A Start Finish Total Start Finish Volume Method MDL | s/mm | s/cc iuside work area Near eut. door 18.2 20:46135 10 10/1350 iuside work area near staircase 18:3320:48135 10 10 1350 inside work area Near elevators 18:3620:51135 10 10 1350 outside WIA Near eutrance dooR 18:40.20:58|35 10 10 1350 outside wlt byth criticalbarrier 18:42/20:57/135 10 10 1350 outside wA ou basement 18:45 20:00135 10 101350 F.B F.B S.B 12 13 14 15 Relinquished by (Signature): Lyushueuskiy Relinquished by (Signature): Comments & Special Instructions Fax Results to 631-584-3395 D0/18/01 Time Date Time Printed Name & Agent: Printed Name & Agent: Relinquished by (Signature): Received for Lab by (Signature): Date Time Date Time Printed Name & Agent: RECEN AEE Printed Name & Agent: UCT 1 8 2001 BYA Bemp:50pm White - Laboratory Yellow - Office Pink - Field NYC-WTC 000097893