Air monitoring data chain of custody form

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io AND □ 2 hrs □ 6 hrs TURNAROUND TIME

□ 48 hrs □ Standard ~ i o

I ASSOCIATES INC. CHAIN OF CUSTODY FORM □ 4 hrs □ 24 hrs □ 72 hrs □ Other u o o o PROJECT INFORMATION oW 7, .5 4c. Rotameter Number: c CT 1. Client: 2. Project Name 3. Project # 4. Project Monitor: o' "0 TO 2a.ProjectAddies8 3a. Task # 4a. Air Sampler: O A o O1 51 5. Date; 6. Abatement Locatinn; 7. QPCM (0.B micron MCE) 8-TMTEM to “15 micran MCE) 9. Type; c. □ Abatement f. □ Environmental O Gassette/Hlter Manufacture _ - CasseWe/FiJlw Manulaclure a. □ Background d. □ Post-Abate (|>EjArnbient o o b. □ Pre-Abate e.QOSHA h. □ Other c Lot # __ __________ Lot#__ __________ 3 ) CD DAILY AIR SAMPLE RECORD O

10. 11. 12. Sample Location 13. Time (24 hrs clock) 14. Flow Rate (Umin.) 15. 16. 17. Sample I.D. Pump 13a. Start 131). End 13c. Total 14 a. Start 14b. End 14b. Total Air Vol. # Fibers/Fields Fiber Cone. F/CC 12a. 12b. 12c. Sample Coordinates Number Number IWA OWA Avg (liters) Minus Blank

Field Blank TiiiBaiaitT Field Blank R >S C‘ IMS') I3‘> lo.Q [OQ 1(2 l<iao 1.3 « 10 fi 10.6 10 I^^F^ l*C " O2-v~' /R<0 '3c) lox? (0 |3od a "T~"A-d 02^^^ i f\ I tsi 'SO 1^0 10.0 IQO Id t’K'O l5o5 10,^ 10 d Id iStO

CHAIN OF CUSTODY LAB INFORMATION (ATC ELAP # 10879, ATC NVI AP # 1187) 18. Relinquished By: 19. Received By; 20. Date: 21. Time; 22. Lab Name; ./^rc 23. Date: 24. Time; 25. Microscope Make/Serial #: □ Nikon Labophot 238913 a. Analyzed By: □ Nikon Labophot 238917 11 b. QC By: c. Lab Batch #: □ Nikon Labophot 239079 III Analysis Methodology 26. ATC Project Manager 28. Comments: 27. Result To: PCM - NIOSH 7400A 3'.AX^ Beeper/Phone #'s TEM - AHERA

WHITE - File YELLOW - Client/Report PINK - Lab GOLDENROD - Field NY-1 (1/01)