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CLIENT:. SAMPLING DATE:
§ NewYoik.WOS PROJECT: ADDRESS: Z77 F “0
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Fax: 7,8)729-1576
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00 FIELD DATA LAB ANALYSIS ]
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SAMPLE E O TIME TIME VOLUME CASSETTE o
TYPE LOCATION BEF. AFTER PER PER LAB ID# o
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ID# S R IN OUT (liters) 25MM 37MM
(Ipm) (Ipm) FIELD CC 3
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BL. TEST METHOD:
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o SAMPLE TYPE; A-BACKGROUND, B=PREABATEMENT. C=DURING ABATEMENT. D-POS l ABATEMENT 4= -4
E=OUTSIDE WORKAREA. F=INSIDE WORKAREA. G=MICROTRAP EXHAUST DISCHARGE — to
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H=DECONTAMINATION FACILITY. I=CRITICAL BARRIER. J=OUTSIDE BLDG<k)FIELD BLANK
■n AIR QUALITY. M=COMPLIANCe MONITORING
Z= HALF FACE. 2 = PAF’R. 3 = TYPE C. 4 = OT HER (SPECIFY):
So TYPE OF RESPIRATORS;
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):
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o ECHNICIAN: ROTAMETER: - PAGE / oZZ
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(-O CHAIN RELINGL'i ! !ED BY: COMMENTS: RECEIVED AI U\B OY:
cn OF METIIOL: of SHIPMENT: SAMPLE CONDI l iON UPON HECEIP,/
JSTOD'l DATF/TIMF DArr/riME: (o- jj- •<-(
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