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Presentation transcript:

Volume / Area (as applicable) ASBESTOS CHAIN OF CUSTODY 600 S. Wagner Road Ann Arbor, MI 48103 Contact: 877-220-3528 | info@pellabs.com Page 1 of For Lab Use Only Lab No. Accept Reject Contact Information Project Information Report Results(Check one) Company: Phone: Project Name: Fax Contact: Cell Phone: Project Location: Email Account #: E-mail: Project ID: Other SAMPLED BY: Name: Date: P.O. Number: RELINQUISHED BY DATE & TIME VIA RECEIVED BY REQUESTED SERVICES (Please Check the Appropriate Boxes) PLM TEM TURNAROUND TIME Bulk Analysis (EPA 600/R-93/116) Vermiculite Attic Insulation (EPA 600/R 04/004) Air- AHERA Bulk- Presence / Absence EPA600/R-93/116 Rush 400 Point Count Air- NIOSH 7402 Bulk- Quantitative [weight%]- Chatfield Same Day Other 1000 Point Count Air- ISO 10312 Dust- Presence / Absence 24 - Hour Gravimetric Preparation PCM Drinking Water- EPA 100.2 Dust- Quantitative [fibers/sq.cm]- ASTM D5755 3 - Day Particle ID NIOSH 7400 Waste Water- EPA 600/4-83-043 5 - Day No. Sample ID (10 Characters Max) Description Volume / Area (as applicable) Comments / Notes 1 2 3 4 5 6 7 8 9 10 REQUESTED SERVICES (Check the Appropriate Boxes)

ASBESTOS CHAIN OF CUSTODY 600 S. Wagner Road Ann Arbor, MI 48103 877-220-3528 | info@pellabs.com Page 2 of For Lab Use Only Lab No. Accept Reject Project Information Company: Guzi-West Inspection and Consult. Project Name: Project Location: No. Sample ID (10 Characters Max) Description Volume / Area (as applicable) Comments / Notes 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

ASBESTOS CHAIN OF CUSTODY 600 S. Wagner Road Ann Arbor, MI 48103 877-220-3528 | info@pellabs.com Page_____of For Lab Use Only Lab No. Accept Reject Project Information Company: Guzi-West Inspection and Consult. Project Name: Project Location: Sample ID (10 Characters Max) Description Volume / Area (as applicable) Comments / Notes