Asbestos chain-of-custody record form, Nov 2001

Machine-extracted title · confidence 90%

Chain-of-custody document specifically designated for tracking asbestos analysis samples collected during the post-9/11 environmental monitoring.

NYC-WTC_000176115

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Z Z -< o ^501 OS’S -< o g HELD DATA COLLECTIONICHArN-OF-CUSTODY RECORD : ASBESTOS ANALYSES ONLY Sanipling Dale; CD

o bJ cn I OFFICE OP .EMERGENCY PREPARRDNESS-USPUS PROJECT REFERENCE NUMBER: ANALYSIS REQUESTED T\TE OFSURFACE* \ “0 o c o cro: NEW YORK DEPARTMENT OF HEALTH (iN>XisnaAiv/i: rouMvsr ll-llARDSURfACE to CT o USPHS MISSION #12: RESIDENTIAL SPKai^fEITIIES IHSSff.THOD OX CD SAMPLING NEW YOR^ CITY O o' 253 BROADWAY, 12TH FLOOR, NEW YORK. NY 10007 mbxMErmiS) foxf^co cor = CARThT. DfiKP o> "0 PH (112) 676-6323 FAX (212) 442-9316 SAMPLING BLDG/LOCATION CS=C4RPeT.SHAG o o cn 3- cn CSP= CARPET. SHORT PILB CD 4:x SurtAOe dUil CIR = CARFIZT, TlfROVZ RUG CD 0 ATftxirne Asbestos Asbestos Fib'US o * VIA: fPJeAis check) ATTN: IJSPnS MISSION (lU RESIDENTIAL ScUMPLING 7 PH: (212) 442-6792 fibers by PCM o (NIOSH 74001 IF byPtM(HIOSH c (X IMtilllriflr.ililii: CAPT Sven Rodenbeck, P3nil Slop E-32.1600 Clifton Road, NE. Atlanta, GA 30333 >0.0K4rc. foPi'mfd aD02> IF<1%. IsJ 3 fc<V(£n3 sample CD |X| E-MAIL to: [email protected] (Ms. Lynn Wilder, CIK) m SQTipIO for lEM t-* 3 o (NIOSH 7402) lorTEM (NY ro co I X I Fax Io: ATIH: CAPT Sven Rodenbeck al (404) 498-0073 and USPHS Mission tf12 at (212 1442-9: 16 S9ft4) ADDITIONAL I G 873 ro ld CO SAMPLING SAAfPLE SAMPLER TYPE OdsteHe SAMPLE START STOP INFORMATION o I M SITE TYPE Pf^«Siinp!inc Flow r<Mi-SaniplIng Ffow NUMBER TTMp TIME In REGARlirNG SAMPLE K5 O ■ t-n H H Outdoois Airborne Asbestos Ml LPM (RIA O- 15 1 X Location; 0 cm’ “ J O Settled DusI Bulk (KISA-O- X Area: BSHlB a -""-I G X O Common Area Airborne Asbestos PL£ LPM [RJ)AO /sli X t'f H M Vacuum Surface Diisi iWGGffl [R)VA-C- dSSEs X Area vacuumed:' / ftvT ■/< O BlSlliiil COz-'a-zz-j-------- —— H < M li Residence I Airborne Asbestos Vacu^ Sur^e Dust LPM jJhl LPM (RIA-RI- 11 10? IS a X X jAtcb vacimmed; Apt: jy-/) / m’ a ' O M TSO 7^ m :s XI U M S H Residence 2 Airborne Asbestos Hl,^ LPM w:o LPM IR1A-R2- I? 1^^ X Floor: 3 A ApL^^jS in ?3 > Vacuiini SiirfHce Dust n<lVA-R2- X Arva vacuumed: I m’ I> S O Airborne Asbestos (RJBA-A Ar.

e^S w X z: Air Sample HlanYs /£ Airborne Asbestos [RIBA-B LS X O 1>

CO M z: G o H ,, RELINQUISHED BY: TJMEZDATE: RELINQUISHED BY: TIMEZDATE: SAMPLES SHIPPED TO: O COMPANY; EMSL Analylical, Inc. O CO ADDRESS-. 307 West 38lh Street o X ' // (Fxi.'tCtexL/FJadi iitFestjatTOK) (LAgoRATOfi) neusti-enj New York, NY 10018 H K RELINQUISHED BY: TlME/DATE: RELlNQUrSHED BY: TIMEZDATE; I ATIN: to PHOKe: •*-Wr»l»IA (ce. D

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RELINQUISHED BY: TI MERI ATE: <L-< S 0«.<« TOR Y SVPBR fUO R> HHi FAX:

CAIUUrjli ______________ (856) 858-1292 EMSL courier I> Cl n o I DATE; o o o co (ANRLYSI) D.MYt AIMBILL B: 03A!33iy NJ CD NO co

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NYC-WTC_000176115Source: NYC Law Department, mirrored locally

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