Chain of custody form for air monitoring data, NYC BOE

z Z <5 o i rn AIR MONITORING DATA AND Page TURNAROUND TIME of 3 -< o co □ 2 hrs □ 6 hrs □ 48 hrs □ Standard^ / I o CHAIN OF CUSTODY FORM □ 4 hrs □ 24 hrs □72 hrs Other /e^2»/I “0 o c o PROJECT INFORMATION CT o 1 Client 2 Protect Name y ^^^4^ 4 Protect Monitor 4c Rotameter Number o' cn "0 4^ 3a Task# o 00 5 Date 6 Abatement Location 7 0 PCM (OBmicronWE) 8 TEM (0 45 mrerpn MCE) ~ 9 Type c □Zbatement 9L f □ Environmental O Cassetle/FilterManulactm _ Casselte/finei Manulacture a □ Background d □ Post-Abate g 5^Ambienl o o Lol# Lot# b □ Pre-Abate e □ OSHA h □ Other c 3 DAILY AIR SAMPLE RECORD CD 3 w 10 11 12 Sample Location 13 Time (24 hrs clock) 14 Flow Rate (L/min ) 15 16 17 G Sample ID 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 CO Number G Number IWA OWA Avg (liters) Minus Blank M O Field Blank H

H Field Blank O 3 23 O 2..O H M O o H o < 3 3 2.0 o M u o M 20 a M S H 2-0 2.0 23

S O /o 2-^ w M / // /5 2.0 /3Z0 3 H

to 2 0 3.0 o o co o CHAIN OF CUSTODY LAB INFORMATION (ATC ELAP # 10879, ATC NVLAP #1187) H 18 Relinquished By 19 Received By 20 Date 21 Time 22 Lab Name 24 Time 25 Microscope Make/Serial # 1"^ □ Nikon Labophot 238913 a Analyzed By II_____________ _/ b QCBy □ Nikon Labophot 238917 S O □ Nikon Labophot 239079 III c Lab Batch# O O Analysis Meltiodology I 26 ATC Protect Manager 28 Comments o 27 Result To PCM - NIOSH 7400A o I co co r Beeper/Phone #'s t TEM - AHERA

to WHITE - File YELLOW - Chent/Report PINK - Lab GOLDENROD - Field NY 1 (1/01)

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