NYC 9/11 Public Portal Document
Balytical.lBC.
CHAIN OF CUSTODY Asbestos
Revised, January-13,2000
Third Part)’ Billing requires written authorization from
EMSL Rep: UVU-Vf__LoU third paitj'
Your Company Name: ___________________ EMSL-Bill to:
Street: ___________________ Street:
Box #: ___________________ Box #:
City/State: _________________ Zip; City/State; Zip:
Phone Results to; Fai Results to:
Name: Name:
Telephone #: Fax#:
Project Purchase Order #:
Name/Numben
1ML4TRIX TURNAROUND
□ Air □ SoU □ Micro-Vac □ 3 hrs □ 6 Hours □ Same Day □ 24 Hours
or 12 Hours' (1 dav)
□ Bulk □ Drinking Water □ 48 Hours □ 72 Hours □ 96 Hours □ 120 Hours
(2 days) (3 davs) (4 davs) (5 Days)
□ Wipe □ Wastewater 1 □ 144+ hours (6-10 Days)
TEM AIR, 3 hoars, 6 hours, Please call ahead to schedule. There is a premimn charge for 3-honr tat; please call 1.800-220-3675 for price prior to sending
samples. You will be asked to sign an authorization form for this service.
*12 hours (must arrive by 11:00 aju Mon - Fri.), Please Refer to Price Quote
PCM-Air TEMAir TEM Water
□ NIOSH,7400(A) Issue 2: August 1994 ; □ AHERA 40 CFR;Part 763'Subpart E □ EPA 100,1 "
----- -----
□ 0SHA.W/TWA
-------------- - .
□ NIOSH 7402 Issue 2
Q 2
23 Other, □ EPA Level n □ NYS 198.2
PLM - Bulk TEM Bulk TEM Microvac/Wipe
□ EPA600/R-93/116 21 Drop Mount (Qualitative) I I ASTM D 5755-95 quanthaxive
2] EPA Point Count □ Chatfield SOP - 1988-02 I I Wipe Qualitative
22 NYS Stratified Point Count □ TEM NOB (Gravimetric) NYY 198,4
□ PLMNOB(Gravimelric) NYS 198,1 221 EMSL Standard Addition XRD
□ NIOSH 9002 —Q Asbestos
22 EMSL Standard Addition PLM Soil □ Silica NIOSH 7500
>EM Air or Bulk 3 EPA Protocol (Qualitative
_ Qualiiative 2] EPA Protocol Quantitative OTHER
Quanritatii'e 23 EMSL MSD 9000 Method Sbsrs/gram □
Client Sample # (s) Total Samples #:
Relinquished; Date; Time;
Received: Date: Time:
Relinquished: Date: Time:
Received: Date: Time:
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NYC-WTC_000220279
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