Chain of custody form for air monitoring data

NYC 9/11 Public Portal Document

AIR MONITORING DATA Page of TURNAROUND TIME AND □ 2 hrs □ 6 hrs □ 48 hrs □ Standard 5 S O C I 2r OF CUSTODY FORM □ 4 hrs 024 hrs □ 72 hrs J^Other I? (4 L PROJECT INFORMATION 1 Client 2 Project Name 3 Project# 4 Project Monitor 4c Rotameter Number t:MM 2a Project Address 3a Task# 4a Air Sampler 8 <? t •J I (. Hoy H P <->C Li

5 Date 6 Abatement Location 7 □ PCM (oem MCE) 8 ^TEM (0 45 m ro MCE) 9 Type c □ Abatement f □ Environmental Tr\ i. Oa-T' C tte/Fift Man f tu _ C ItaTFIt M ul t a □ Background d □ Post Abate g J^Anibient St' tlOD [ Lot# ____________ L 1# 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 Field Blank M O H » 7 Field Blank 7 ? VW" A 9 H O Audi ri u I'V) 3 3 O 7- 8 H M O o Tn f?^T^~tev\CL H o 0 7-^5 tl 28 8 8 8 194^ 3 < 3 M a co 1 I- Kl Wr-tll by ''7 0 o 3 iMl 8 8 8 a H M ChP 3 O Io OT3. li3c 8 8 8 1949 Pan H II 11 M*? 16 2-H( 8 8 co M 3 H Jv 11 MT 1-3 M5 aM3L to IO 8 6 H36 o o LAB INFORMATION (ATC^P # 10879 ATC NVLAP #1187) co CHAIN OF CUSTODY o 18 Relinquished By 19 Received By_________ ------------------------ 20 Date ---------- 21........ - Time- 22 Lab Name i „ 23Date 24 Time 25 Microscope Make/Serial # H M /mta At? WS >5 a Analyzed By

b QC By □ Nikon Labophot 238913

□ Nikon Labophot 238917

S O Hi c Lab Batch# □ Nikon Labophot 239079

O Analysis Methodology O 26 ATC Project Manager 28 Comments v/ I 27 Result To 4-*- irw TI J----------------------------- PCM NIOSH7400A o o co r a.K-t-h I Oct Beeper/Phone # s TEM AHERA co WHITE File YELLOW Chent/Report PINK Lab GOLDENROD Field NY1 (1/01) o Ui cn

NYC-WTC_000175446