Chain of custody form for air sampling, Sep 2002

NYC 9/11 Public Portal Document

«IM.Y/Tni©iU. PSC (5^ R? ovt //n <75“ AIR SAMPLING PSC Work Order #

[\l CHAIN OF CUSTODY goZ»4»W a. 4418 Pottsville Pike phone: (610) 921-8833 Page \ A Reading, PA 19605 fax: (610) 921-9667

PO# Quote # Name Name S\w\ Cf~iV\Y\ lompany Report Submit ;ompany Results Mailing Address ■ ____________________________ Invoice tailing Address '--oH ill. £ Sty state ZIP CD CD To; _________Ki-Af_______ Stale A ZIP To: [Telephone # Fax# 0) -elephone IcreditCar^foOncludewp. dale) I CO PJ a m COMMON MATRIX TYPES Job/Project Name:_____\2.U TA____________________ DJ I pl Q □ 1-4 1. Badge (OVM/Faasive Monitor) 6. Wipe (specify type) Sampler's Name(s): n^vCZXvx________ H CD 2. Tube (specify type: charcoal, silica, XAD, etc) 7. Tedlar Bag Sampling Location (Specify State): ______yj vj ■____________ H O 3. Train (filter + tube, 2 tubes in series, etc) B.Summa Can Due_D^e_(R^h2esuite7Bquirer^bapproyaiji2_^ZZZZZZZZZZZZZ h3 4. Filtcr/Cassette (specify PVC, MCE, OFF, etc.) 9. PUF/Resin/XAD REPORTING REQUIREMENTS (Circle all that apply); XI O 5. impinger Solutions (specify components) 10. Other (list details): Full Data Package Reduced Deliverables Pkg Electronic Data Deliverables H M O O H O FINAL AIR I H Z MATRIX MEDIA SAMPLE FLOW RATES I 3a SAMPLE DESCRIPTION VOLUME SAMPLE ANALYSIS REQUESTED o 73 a M M S H HI I (ID must match container labels) (see above list) (list catalog {specify; number) minutes, etc) DATE TIMES (specify units; Start Stop ) Initial Final Average Use aliachments if necessary. Please specify method requirements. 73 S > f ' 1 -Vcz. I V^O k-cx Sa O- JZ T^e/yvearboA S O f 2 I Em o YX e-.A to i 3 ) a,'-) M-UfC 3 VAo A 'llD LTD IS-A 1 4 co U 5 M nj w H 0. 6 7 O O 8 CO n O 00 9 w H 10 K m I IYO a (1) Relinquished by;^ Date Time (2) Received by: Date Time S OJo Q \ Q>v\7 o n (4) Received by; o w (3) Relinquished by; Date Time Date e»i6 , f TimG I o o 0-__________________________________________ co 01 FED-EX^ CO O Method of Delivery: UPS PSC Courier Client US Mail Other cn co

NYC-WTC_000175240