Z KAMlUNbULIANIS CHAIN OF CUSTODY FOR ASBESTOS AIR MONITORING
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g Long Island City CLIENT: SAMPLING DATE: O \ o
1^ NewYofMllOe PROJECT: ADDRESS:
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101:1718)729-1997 "0
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o Fax: (718 729-1^76 CT
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FIELD DATA [ LAB ANALYSIS "0
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R W 03
FLOW FLOW FIBERS FIBERS
SAMPLE E O TIME TIME VOLUME ^-JC^ETTE
TYPE LOCATION BEF. AFTER PER PER LAB ID# TsMM^ 37MM o
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ID# S R IN OUT (liters) o
(Ipm) (Ipm) FIELD CC c
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1 TEST METHOD. CD
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TEM
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n K \ \ TUfthl-AROUND Time:
IMMEDIATE
12-HOUR
24-HOUR
24-HOUR
OTHER:
ANALYST:
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DATE OF ANALYSIS:
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TIME OF ANALYSI§:
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o SAMPLE TYPE: A=BACKGROUND, B=PREABATEMENT, C=DURING ABATEMENT, D=POST-ABATEMENT
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H E=OUTSIDE WORK AREA, F=INSIDE WORK AREA, G=MICROTRAP EXHAUST DISCHARGE tnm
K H=DECONTAMINATION FACILITY, l=CRITICAL BARRIER, J=OUTSIDE BLDG., K=FIELD BLANK
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L= AIR QUALITY, M=COMPLIANCE MONITORING
1 = HALF FACE, 2 = PAPR, 3 = T YPE C, 4 = OTHER (SPECIFY):
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TYPE OF RESPIRATORS.
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TYPE OF WORK: 1= BLDG DECON, 2 = PLASTICIZING, 3 = GROSS REMOVAL, 4 = GLOVEBAG, 5 = CLEANING,
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o 6 = ENCAPSULATION, 7 = BAGOUT, 8 = OTHER (SPECIFY); o tn
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TECHNICIAN: Y • ROTAMETER; PAGE OF 3^
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co CHAIN RELINQUISHED BY. H . V COMMENTS: RECEIVED AT LAB BY. ju/C
OF METHOD OF SHIPMENT. SAMPLE CONDITION UPON RECEIPT.
JUSTODV DATE/TIME: DATEZTIME:
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