New Jersey Department of Health

Consumer, Environmental and Occupational Health Service

Environmental and Occupational Health Assessment Program

P. O. Box 369, Trenton, NJ 08625-0369

ASBESTOS MANAGEMENT PLAN - SUMMARY OF LABORATORY SAMPLES

(A copy of the Chain of Custody form and Laboratory Analysis form for each sample MUST be included.)
FOR STATE USE ONLY
Building Assessed

Sample Number	Name of

Sample Collector	Type*	Homo-geneous

ID No.	Exact Location	Result	Lab ID Number	Date	Manner to Determine Location**	Method of Analysis
%	Type Asbestos
Collected	Analyzed
*Type Codes:

1 - Air

2 - Bulk

3 - Surface	**Codes ‑ Manner Used to Determine Sampling Location (List all reasons which apply for each sample):

A - The total extent of each homogeneous area was analyzed.

B - The number of samples are as required.

C - The material at each selected location is representative of the homogeneous area.

D - The locations are uniformly distributed throughout the homogeneous area.

E - The locations are randomly distributed throughout the homogeneous area.

F - Each location is reasonably accessible.
ASB-10

MAR 13

H

asb-10, asbestos management plan, summary of laboratory samples

ASB-10, AMP, asbestos, management, plan, summary, laboratory, lab, sample, CEOHS, consumer, environmental, occupational, epidemiology, EEOH

Elaine White

2004-12-20

ewhite

NJDOH