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Lead wipe sample chain of custody form

Machine-extracted title · confidence 85%

Chain of custody form for lead wipe samples used to track the collection and transport of surface samples for laboratory analysis.

NYC-WTC_000174216–000174217
Page image
Scanned page image, NYC-WTC_000174216
OCR text

OCR status: ok · source: pdftotext

z Z

o o io LEAD WIPE SAMPLE DATA AND CHAIN OF CUSTODY FORM f co

I “0 o c o CT o Client Project Name & Address: TRC Field Representative; Page o' New York City Law Department 100 Church St. "0 o Of cn Date: Requested Turnaround Time; TRC Project Manager: TRC Project No. 9L 12.hrs NITIN DAVE O OFFICE PHONE: 212-563-3933 35052-0000-00008 o o CELL PHONE: 917-549-3382 c 3 WIPE SAMPLE INFORMATION CD 3 Area Sampled Sample Location Total Area Sample Number. Surface Description. /(ich (Square CM) Floor Room/Area Description 100 S^ ■ $17 joos^lijlH

V»s^ 1^00 s^

y0 s^ <7^(7 I in X___ 10__ 100 SCM

10 X___ 10_ 100 SCM

10 x__ 10_ 100 SCM

Jlfl-x__ 10_ 100 SCM

SPECIAL INSTRUCTIONS TO LABORATORY Fax Results To (Name) NITIN DAVE at (Number) 212-349-4648

CHAIN OF CUSTODY DOCUMENTATION AND LABORATORY INFORMATION O Relinquished By Date Time Date Time Method of Submittal Comments (Lab) Field □ SciLab

Walk In □ 02031783 o ■jj; tJSMair n Name and Signature: ------- Date Time

o Fed-Ex □ Analyzed By:

o III. Other n Analyzed By: QCBy; 4^ cn 4^ co CD cn

OCR can misread numbers and units. Confirm readings against the page image before using them.

NYC-WTC_000174216Source: NYC Law Department, mirrored locally

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