Chain of custody form for air monitoring data

NYC 9/11 Public Portal Document

AIR MONITORING DATA Page 1 of H TURNAROUND TIME AND □ 2 hrs 06 hrs □ 48 hrs □ Standard ASSOC CHAIN OF CUSTODY FORM □ 4 hrs 024 hrs 072 hrs P^Other jSi-Xh. PROJECT INFORMATION 1 Client 2 Project Name 3 Project# 4 Project Monitor 4c Rotameter Number 111 M I 5 fl 4 fi 6 A//a Kor 2a Project Address ICO f 3a Task # 4a Air Sampler Jn C t f-y HPcc 5 5 Date 6 Abatement Location 7 □ PCM (0 e m 0 MCE) 8 ^TEM (0 45 me on MCE) 9 Type c □Abatement f □ Environmental

/ lA li o't" U ot C tte/FII M t tu C 1tld/Fill M f I MMx, a n Background d □ Post Abate g^^Ambient T Lot# Lot# C) it?c^l C b □ Pre Abate e □OSHA h □Other

DAILY AIR SAMPLE RECORD 10 11 12 Sample Location 13 Time (24 hrs clock) 14 Flow Rate (L/min) 15 16 17 w Sample I D Pump 12a 12b 12c Sample Coordinates 13a Start 13b End 13c Total 14a Start 14b End 14b Total Air Vol # Fibers/Fields Fiber Cone F/CC G Number Number IWA OWA Avg (liters) Minus Blank co G Field Blank Ft O i r Field Blank / St-alecj 3 7 —■ H O

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W OUT- iii& ^H| O e 3 Ft G H kF n L. bbyZ o7iq iiat <c 3 3 19^ M o o CHAIN OF CUSTODY LAB INFORMATION (ATC ELAP # 10879 ATC NVLAP #1187) co o 18 Relinquished By 19 Received By 2q Date 21 Time 22 Lab Name 23 D^te 24 Time 25 Microscope Make/Serial # H rszMzz II a Analyzed By b QCBy TTRs □ Nikon Labophot 238913 □ Nikon Labophot 238917

S O in c Lab Batch# □ Nikon Labophot 239079

o Analysis Methodology 26 ATC Project Manager 27 Result To Y hUxH ________ 28 Comments o Io Y' o Lk PCM NIOSH7400A o Beeper/Phone # s -77-__ TEM AHERA co tC. co WHITE File YELLOW Client/Report PINK Lab GOLDENROD Field NY1 (1/01) o Ui Ui

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