Chain of custody form for air monitoring data, NYC BOE

NYC 9/11 Public Portal Document

AIR MONITORING DATA Page of 4 TURNAROUND TIME AND □ 2 hrs 06 hrs □ 48 hrs □ Standard S 8 O C 2r OF CUSTODY FORM □ 4 hrs 0 24 hrs 072 hrs j^Other La I, PROJECT INFORMATION 1 Client 2 Project Name 3 Project# 4 Project Monitor j^l liLM________ 4c Rotameter Number

2a Project Address 3a Task # 4a Air Sampler '-j-' C b too Ho lev- •JlL' < Ho/ H P GO s 5 Date 6 Abatement Location 7 □ PCM (08m MCE) 8 TEM (0 45 m MCE) 9 Type C □ dement f □ Environmental ■LTirh J. c ette/FII M III t Mm a □ Background g J^Am blent C ss tle/FIt M ( hl d □ Post Abate hop I L I# _______ LOI# O?fo69fZ b □ Pre Abate e □ OSHA h □Other

DAILY AIR SAMPLE RECORD 10 11 12 Sample Location 13 Time (24 hrs clock) 14 Flow Rale (L/min) 15 16 17 W Sample 1D 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 03 G Field Blank M O H Field Blank H O <Aizirli 4ori ux no 23 23 7- 8 O H M Tk PZ (• g.~tev \ CL. O O 8 iqnM H O 3 8 < 3 M a miL Wqll by O M 07:?'f 11 0 6 a M 3 H 9 23 HqI| C‘tP S O Io 0 73. Ii3c 3 6 9 1949 H 15 96 8 8 w M II 11 MS 2.H( S 19.30 23 M He? H IJ II 47 Ito 49 aqi. 8 8 8 1936 to o o LAB INFORMATION (ATC^P # 10879 ATC NVU\P #1187) co CHAIN OF CUSTODY o 18 Relinquished By 19 ReceivedBy, 20 Date 21 Time 22 Lab Name 23 Date 24 Time 25 Microscope Make/Senal # H a Analyzed By /yd" □ Nikon Labophot 238913 K I □ Nikon Labophot 238917 b QC By

s in c Lab Batch # □ Nikon Labophot 239079 O o Analysis Methodology 26 ATC Project Manager 28 Comments o I 27 Result To PCM NIOSH7400A o o co r i.Yfc,/A |Ol< Beeper/Phone # s TEM AH ERA IC. co WHITE File YELLOW ClienVReport PINK Lab GOLDENROD Field NY1 (1/01)

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