Country:
Sampled By Name: Sampled By Signature:
NIOSH 7400 AHERA 40 CFR, Part 763
NIOSH 7400 w/ 8hr. TWA NIOSH 7402
EPA Level II
PLM EPA 600/R-93/116 (<1%)
ISO 10312*
PLM EPA NOB (<1%)
POINT COUNT TEM EPA NOB
400 (<0.25%) 1,000 (<0.1%) NYS NOB 198.4 (Non-Friable-NY)
POINT COUNT w/ GRAVIMETRIC TEM EPA 600/R-93/116 w Milling Prep (0.1%)
400 (<0.25%)
1,000 (<0.1%)
NIOSH 9002 (<1%)
NYS 198.1 (Friable - NY)
NYS 198.8 (Vermiculite SM-V)
Positive Stop - Clearly Identified Homogeneous Areas (HA)
Date/Time:
Date/Time:
Controlled Document - COC-05 Asbestos R15 4/23/2021
Other Test (please specify)
*Please call with your project-specific requirements.
PCM Air TEM - Air
PLM - Bulk (reporting limit)
NYS 198.6 NOB (Non-Friable - NY)
TEM - Bulk
TEM Air 3-6 Hour, please call ahead to schedule. 32 Hour TAT available for select tests only; samples must be submitted by 11:30 am.
Billing Contact:
(If applicable, EMSL will
samples collected:
State of Connecticut (CT) must select project location:
No. of Samples
in Shipment
Turn-Around-Time (TAT)
Email(s) for Report:
Email(s) for Invoice:
Purchase
Order:
Project
Name/No:
Project Information
Asbestos Chain of Custody (Air, Bulk, Soil)
EMSL Order Number / Lab Use Only
Customer Information
Customer ID:
Billing Information
Billing ID:
Company Name:
Street Address: Street Address:
City, State, Zip: City, State, Zip: Country:
Phone: Phone:
Company Name:
Contact Name:
Received by: Date/Time
EMSL Analytical, Inc.’s Laboratory Terms and Conditions are incorporated into this Chain of Custody by reference in their entirety. Submission of samples to EMSL Analytical, Inc. constitutes
acceptance and acknowledgment of all terms and conditions by Customer.
Method of Shipment:
Sample Condition Upon Receipt:
Sample Number
Special Instructions and/or Regulatory Requirements (Sample Specifications, Processing Methods, Limits of Detection, etc.)
Relinquished by:
Filter Pore Size (Air Samples) 0.8um 0.45um
Sample Location / Description
Volume, Area or Homogeneous Area
(Air Monitoring Only)
TEM - Settled Dust
Microvac - ASTM D5755
Wipe - ASTM D6480
Qualitative via Filtration Prep
Qualitative via Drop Mount Prep
Soil - Rock - Vermiculite (reporting limit)*
PLM EPA 600/R-93/116 with milling prep (<0.25%)
PLM EPA 600/R-93/116 with milling prep (<0.1%)
TEM EPA 600/R-93/116 with milling prep (<0.1%)
TEM Qualitative via Filtration Prep
TEM Qualitative via Drop Mount Prep
Received by: Date/Time
Relinquished by:
Page 1 of
If Bill-To is the same as Report-To leave this section blank. Third-party billing requires written authorization.
PHONE:
EMAIL:
Commercial (Taxable)
Residential (Non-Taxable)
AGREE TO ELECTRONIC SIGNATURE (By checking, I consent to signing this Chain of Custody document by electronic signature.)
24 Hour 48 Hour 72 Hour 96 Hour
1 Week 2 Week
32 Hour
3 Hour
6 Hour
4-4.5 Hour
