Chain of custody form for air monitoring data, NYC BOE

NYC 9/11 Public Portal Document

3 Si 1 AIR MONITORING DATA Page of TURNAROUND TIME AND □ 2 hrs □ 6 hrs □ 48 hrs □ Standard SSOCI TES INC CHAIN OF CUSTODY FORM □ 4 hrs □ 24 hrs □ 72 hrs j^Other Pu ) PROJECT INFORMATION 1 Client 2 Protect Name 3 Project# 4 Protect Monitor 4c Rotameter Number I3|M BOt 2a Protect Address ICC7 HeLte. if- 3a Task # 4a Air Sampler —, ; ) Oh c-Y________ HP U-C 5

5 Date 6 Abatement Location 7 □ PCM (0 8 m MCE| 8^TEM(045ni ro MCE| 9 Type / □Abatement f □ Environmental Tr 4- (OclV Cass llemil M I t _ C 1tle/FIt M uf CW MMT a □ Background d □ Post Abate g [^Ambient c F -^i-ic c I Lt# ______________ Lt# 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 10 Pump 12a 13a Start 13b End Total Air Vol # Fibers/Fields Fiber Cone F/CC '/';,A 12c Sample Coordinates 13c Total 14a Start 14b End 14h G Number Number IWA Avg (liters) Minus Blank D3 G M « Field Blank Sts- O H H O t >1 Field Blank

23 23 (3 1150 155:2 24 a. 8 19 3^3 O H M O O IS S5 AH3 H o s G 8 8 1949 M D k J fA o 23 a H S H Is 1155 5MM 5* 8 S’ I9i52 M 23 > G 12 1151 1601 14 4 S O IL 8 8 8 1952 P.T Pt Tc-icln^^a Lo,. J e 1^ 3 I2cc 2HM 8 8 1962 w M 23 H I f PA to >8 120 2 I60C 8 8 o o co CHAIN OF CUSTODY LAB INFORMATION (ATC ELAg 10879 ATC NVLAP #1187) o 18 Relinguished By 20 Date 21 Time 22 Lab Name I ^^ate 24 Time R25 Microscope Make/Senal # 23 Date 24 Time H □ Nikon Labophot 238913 □ Nikon Labophot 238917 III c Lab Batch# □ Nikon Labophot 239079

o Analysis Methodology 26 ATC Protect Manager 28 Comments o I 27 Result To .> mt A_______________ PCM NIOSH7400A o o s{'s'lQ~hAi CQ Beeper/Phone # s TEM AHERA Ui WHITE File YELLOW Client/Report PINK Lab GOLDENROD Field NY 1 (1/01)

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