z |\AM vUNdULlANb
CHAIN OF CUSTOI? ’"OR ASBESTOS AIR MONITORING
35-4036thStfeel Z
o -<
client>-3^cX<^ sampling DATE: '323^. o
UbUsl
g Long Island City
o NewYork. 11105 PROJECT: ADDRESS: /// _k
I Tel: (718 729-1997
o “0
o c
o Fax: (718 729-1876
zw-vyTVA- CT
o'
00
KJ FIELD DATA ir LAB ANALYSIS "0
o
CO W
R 9L
FLOW FLOW FIBERS FIBERS
SAMPLE E O TIME TIME VOLUME CASSETTE O
TYPE LOCATION BEF. AFTER PER PER LAB ID# o
ID# S R IN OUT (liters) 25MM 37MM o
(Ipm) (Ipm) FIELD CC c
P K 3
CD
TEST METHOD;
(5 <C' 0^ 3
:M TEM
I3cc <lt ■ c i 2-U
TURN-AROUND TIME:
6. IP [0 [
IMMEDIATl
12-HOUR
fl!? lo IZOp
24-HOUR
333 [ C? ^O'-C I
IfL r-^O
z. u? f<7 I2^P
0
<! 3^ 24-HOUR
OTHER.
s
CZf
31 i^c-a I
O
IdC
ANALYST;
33. 3^ =<
33 _____ /1 0
,z-'A(r<7 '55
r>o 3
DATE OF ANALYSIS:^. -4
to
(o-S-®)
TIME OF ANALYSIS:
Q
SAMPLE TYPE: A=BACKGROUND. B=PREABATEMENT, C=DURING ABATEMENT. D-POST-ABATEMENT
H
K E=OUTSIDE WORK AREA, F=INSIDE WORK AREA. G=MICROTRAP EXHAUST DISCHARGE
I H=DECONTAMINATION FACILITY, ^CRITICAL BARRIER, J=OUTSIDE BLDGZ'K>FIELD BLANK
L^AIR quality. M=COMPLIANCE MONITORING
s
o TYPE OF RESPIRATORS; 1 = HALF FACE. 2 = PAPR, 3 = TYPE C. 4 = OTHER (SPECIFY).
o TYPE Of* WORK. 1= BLDG DECON. 2 = PLASTIClZfNG. 3 = GROSS REMOVAL. 4 GLOVEBAG, 5 = CLEANING,
o
I 6 = ENCAPSULATION, 7 = BAGOUT, 8 = OTHER (SPECIFY):
o
ECHNICIAN;|f;^j7^ HOTAMETeR;/;^<
PAGE^ OF
co
CHAIN RELINfiUlSHED BY: COMMENTS: RECEIVED A r LAB OY, Q \>
(JI
OF METHOD OF SHIPMENT: SAMPLE CONDITION UPON RECEIPT: <^'1
URTODVlDATF/TIMF DATF/TIMF (o. O I
OCR can misread numbers and units. Confirm readings against the page image before using them.