Chain of custody form for indoor air quality survey at

NYC 9/11 Public Portal Document

' EMSL Analytical, Inc. Asbestos

CHAIN OF CUSTODY Revised January 1, 2000 L-ioi • 17cT c' Third Party Billing requires written authorization I EMSL Rep: Ellen Podell from third party

Your Company Name: C f} , , cl1 trot.S (/ f'f j, GE>\1SL-Bill to: Street: Street: /7 D v/,~ ~-f- 5t Box : — Box #: Zip: City/State: Zip: City/State: >,Q~•~,~~' ,,, `, I Phone Results to: Fax Results to: r ~J Name: - IL1 Name: 54e'ollt'ti /4'~f;yc•-c-..f c I Telephone #: Fax #: S- /E -576 —O73 Project Purchase Order #: Name/Number: I MATRIX TURNAROUND

0 Micro-Vac 0 3 hrs 0 6 Hours 0 Same Day 0 24 Hours I ❑ Air 0 Soil or 12 Hours" (1 day) 0 Drinking Water 0 48 Hours 0 72 Hours 0 96 Hours 0 120 Hours ❑ Bulk (2 days) (3 days) (4 days) (5 Days) I 144+ hours (6-10 Days) ❑ Wipe 0 Wastewater - r . .....-... _.._. - __ _ _, -- 1 LM A11L .3 [tours. o nouns, rtcasc uu aucau w ac..c..~.... ... ~.... _ samples. You will be asked to sign an authorization form for this service. '12 hours (must arrive by 11:00 a.m Mon- Fri.), Please Refer to Price Quote

PCM - Air TEM Air TEM Water - ❑ NIOSH 7400(A) Issue 2: August 1994 ❑ AHERA 40 CFR, Part 763 Subpart E [ j EPA 100.1: ❑ OSHA w/ TWA ❑ NIOSH 7402 Issue 2 ❑ EPA 100.2 .. LI NYS 198.2 I ❑ Other: QfEPA Level II

PLM - Bulk TEM Bulk TENT Microvac/«'ipe ❑ EPA 600/R-93/116 ❑ Drop Mount (Qualitative) ❑ ASTM D 5755-95 quantitative I [] EPA Point Count ❑ NYS Stratified Point Count ❑ Chatfield SOP -1988-02 ❑ TEM NOB (Gravimetric) NYS 198.4 ❑ Wipe Qualitative

Li PLM NOB (Gravimetric) NYS 198.1 ❑ EMSL Standard Addition XRD NOSH 9002 ❑ Asbestos ❑ EMSL Standard Addition PLM Soil ❑ Silica NIOSH 7500 SEM Air or Bulk ❑ EPA Protocol Qualitative I O Qualitative ❑ Quantitative ❑ EPA Protocol Quantitative ❑ EMSL MSD 9000 Method fibers/gram OTHER LI Client Sample # (s) I - f2 /314,,.4- Total Samples;: / Relinquished: Date: /f,/2./0/ Time: ~~ ~~"'~`' -

I Received: Ur t Date: ' \ Time: (O` Relinquished: Date: Time:

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