Chain of custody form for air monitoring samples, Oct 2001

NYC 9/11 Public Portal Document

KAMLUNSULIANI3 35U036lh Sheet CHAIN OFCUST| ' OH asblskjs air monitoring r Long Island City CLIENT;-Z) <2-/4 Z’ SAMPLING DATE; /</'- N6wYorM)106 PROJECT: ADDRESS; Tel:R72J-W zo/r7 71^717- Fax:(718)729-1576 [ FIELD DATA ][ LAB ANALYSIS R w SAMPLE Z/'TY z/7 I E o TIME TIME FLOW FLOW VOLUME FIBERS FIBERS CASSETTE TYPE DEF. AFTER PER PER ID » IO* S R IN OUT (lilois) 25MM 3ZMM (Ipm) (Ipin) HELD CC P K 0*1 I S p. /

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,1..... .... ........ ........ ............................... ................ ..........Jt o > SAMPLE TYPE: A=BACKGROUND, B=PREABATEMENT, C=nURING ABATEMENT, O=POSr-ABATeMENT 2 H 0=0 K E=OUTSIDE WORK AREA, F=INSIDE WORK AREA, G=MICROTRAP EXHAUST_qiSCHARGE ~o I H=DECONTAMINAT!ON FACILITY, CCRITICA! BARR!ES^.P-OUTSIDE 0LDG(f K=FIELD BLANK orn I—i AIR QUALITY, M=COMPLIANCE MONITORING zo s ■sZi tnm o TYPE OF RESPIRATORS: 1 = HALF FACE. 2 = PAPR, 3 = TYPE C, 4 = OTHER (SPECIFY): o o TYPE Of^ WORK: 1= BLDG DECON, 2 = PIASTiCIZING, 3 = GROSS REMOVAL, 4 = GLOVEOAG, 5 = CLEANING, qS >0 I 6 = ENCAPSULATION, 7 = DAGOUT, 8 = OTHER (SPECIFY): o 2 o ox TECHNICIAN: ROTAMETER: ■ / >- PAGE / OF o to OX j CHAIN RELINGUISHED BY; COMMENTS: RECEIVED A l LAB DY. OD O METHOD OF SHIPMENT: SAMPLE CONDI HON UPON RECEIPT. •9^ inUSTOnMDATFITIMF- ' .n 11 ; fim

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