Chain of custody form for indoor air quality survey at

NYC 9111 Public Portal Document

EMSL Analytical, Inc. Asbestos

_ CHAIN OF CUSTODY Revised January 1, 2000 Liol • r7(* EMSL Rep: Ellen Podell Third Party Billing requires written authorization

I from third parry Your Company Name: ft R 1.'l EMSL:Bill to: Street: 7 -f 5 . Street:

Li Box #: City/State: - - l~~ai ivtl~ T /{~ Zip: Box #: City/State: Zip:

I Phone Results to: Name: _tj~ Fax Results to: Name: S1q/t 7J /

Telephone #: Fax #: $/6 ,j76 --VO 3 I Project Name/ umber: (0 ~~t'y.~J c ~[ ~ rc l A .h / Purchase Order #:

I ❑ Air 0 Soil MATRIX

0 Micro-Vac 0 3 hrs TURNAROUND

0 6 Hours 0 Same Day 0 24 Hours or 12 Hours' (1 day) I ❑ Bulk 0 Drinking Water 0 48 Hours (2 days) 0 72 Hours (3 days) 0 96 Hours (4 days) 0 120 Hours (5 Days) ❑ Wipe 0 Wastewater 144+ hours (6-10 Days) I TEM Alta. 3 hours, o hours, rlease call ahead to schedule. There is a premium charge for 3-hour tat; please can 1-tfuo-ZZu-3675 for price prior to sending 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

Ii PCM - Air TEM Air ❑ NTIOSH 7400(A) Issue 2: August 1994 ❑ AHERA 40 CFR, Part 763 Subpart E TEM Water ❑ EPA 100.1-- ❑ OSHA w/ TWA ❑ NTIOSH 7402 Issue 2 ❑ EPA 100.2 a I ❑ Other: ,EPA Level II NYS 1983- . - =;

PLM - Bulk TEM Bulk I ❑ EPA 600/R-93/116 ❑ EPA Point Count ❑ Drop Mount (Qualitative) ❑ Chatfield SOP- 1988-02 TEM Microvac/Wipe''~ ❑ ASTM D 5755-95'quantitative ❑ Wipe Quatative ❑ NYS Stratified Point Count ❑ TEM NOB (Gravimetric) NYS 198.4 I ❑ PLM NOB (Gravimetric) NYS 198.1 ❑ NIOSH 9002 ❑ EMSL Standard Addition ❑ Asbestos ❑ EMSL Standard Addition PLM Soil ❑ Silica NIOSH 7500 I SEM Air or Bulk ❑ Qualitative ❑ EPA Protocol Qualitative ❑ EPA Protocol Quantitative OTHER ❑ Quantitative ❑ EMSL MSD 9000 Method fibers/gram

Client Sample # (s) 13 - i,2 /3'14,,,1— Total Samples #: Ic— I Relinquished:

Received: `, f iv~Ls. ` Date:

Date: f/ 2-_O/

2—W o \ Time:

Time: o9;YU (p.

I Relinquished: Date: Time:

Page _of_

NYC-WTC 000108570