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Microvac sample chain of custody form

Machine-extracted title · confidence 85%

Chain of custody document for Microvac samples collected from 100 Church Street by the Law Department.

NYC-WTC_000177251
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Scanned page image, NYC-WTC_000177251
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

I V E TRCI Client micrAvac sampl I Project Ns le & Address: DATA AND|CHAIN OF Cl{s'jhODY FORM TRC Field Representative: Page New York City Law Department 100 Cf irchSt. / of Dale: Requeslei rumaroundTime: TRC Project Manager: TRC Projeci No. 12 hrs NITIN DAVE OFFICE PHONE: 212-563-3933 35052-0000 OOOOB CELL PHONE: 917-549-3382 WIPE SAMPLE INFORMATION I Sample Number. Surface Description. Area Sampled Centimeters Total Area (Square CM) Floor Sample Location____________________ . Room/Area t sscrlption _____ /IO x__ 10_ o o 00 SCM z o m 10 X__ 10_ z niPWf!io7/'‘iyPk OOSCM

co 00 SCM c CD m 10 X__ 10_ o 00 SCM o 10 X__ 10_ -□ OOSCM JI o -I m 10 X 10 O 00 SCM m O JI OOSCM a m JI z 00 SCM p N* CO 00 SCM m

rci o s SPECIAL INSTRUCTIOriS TO LABORATORY Fax Results To (Name) NITIN DAVE al (Num sr) 212-349-4648 CHAIN OF CUSTODY DOCUMENTATION ANO L; JORATORY INFORM ATION Relinquished By ~ Dale Time ~ ■ ■ ■ I- F^Qcei^d ■-= Date Time Method of Submittal Comments (Lab) Field Walk In u □ ScILab Analyze TEM ASTM 5755 JJSt "T'’ 1 > 5 6 o -jj— -------------- u 'I o III. US Mail Fed-Ex Olher TT n Name antJ Signature: Analyzed By: Dale Time

Analyzed By; o QCBy:

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NYC-WTC_000177251

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NYC-WTC_000177251Source: NYC Law Department, mirrored locally

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