NYC-WTC_000117471
EPA
USEPA Contract Laboratory Program
Generic Chain of Custody SHO VAI
Origination ID: 033982476 10112002 1035185
Request Type: O
BIN#: 1083375
Zp Cork:
Confirmation &
HPD Sequence if:
FloorfApt:
Requester Name:
Normalized Address:
Project Leader:
Activity:
Agency:
10280 Date Shipped: 11/4/2002
0020210105567
805309 Carrier Name: Hand Delivered
Alrbill:
Shipped to:
Glenn Kassis eas EMSL Analytical Inc
375 South End Avenue/ road Weet aan atest
alex kazakov jew York NY t
212) 290-0051
Special Pre Monitoring er)
Chain of Custody Record Samples
Santos’ Cn Make __|
Relinqzished By (Date (Time) Received By (Date / Time)
t And Ca het hh wa {2/02
2 PN loki baeeare— i/2fr
* Swat Wu L,
— QU
SAMPLE No.
Coll, Method! ANALYSS! TAG Naf RESIDENCE?
SAMPLER TURNAROUND PRESERVATIVE? No, COMMON AREA ID
ft Botte.
SAMPLING VOLUME (L)/ SAMPLECOLIECTION DURATION —CALC.
LOCATION AREA (cm DATETINE (nk) Vol {L)
05567-305-561
bulk sample/ HVAC (Std) 669 (1) basement
alex kazakov
mechanical phoe wom area: S$: 11/1/2002 <7 0.00
erhaust duct E: 14/1/2002 st <y i
Shipment for Case
Complete?
Sampte(s} to be used for isboratory QC:
Additional Sampler Signature(s):
Chain of Custody Seal Number:
Analysis Key:
HVAC = HVAC
Shipment iced?
TR Number:
PR provides preliminary results. Requests far preliminary resulta will increase anatyticel costs.
Send Copy to: Sampie
10280-033982476-110202-0006
Ait flow rates are C/Iin
Management Cffice, 2000 Edmund Halley Dr., Reston, VA. 20191-3400 Phone 703/264-9348 Fax 703/264-9222
WTC
FAS2S WIC Page 1 of 1
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NYC-WTC_000117471Source: NYC Law Department, mirrored locally