APPENDIX E FIELD FORMS TROY ASBESTOS PROPERTY EVALUATION
CHAIN OF CUSTODY RECORD MT-DEQ 303 N. Third Street Troy, MT 59935-1170 Lab # Sample # TT-00001 TT-00002 TT-00002 TT-00003 TT-00003 TT-00004 TT-00005 Location Lot Lot Lot Lot Lot Lot Lot Matrix Air Air Air Air Air Air Air Sample QC Type Lot Blank Lot Blank Lot Blank Lot Blank Lot Blank Lot Blank Lot Blank Sample Date 4/26/2007 4/26/2007 4/26/2007 4/26/2007 4/26/2007 4/26/2007 4/26/2007 Site #: 08BC
No: Troy-Lot Blank- Chain 1
Lab: EMSL-Mobile Lab
PDA
SAMPLES TRANSFERRED FROM Special Instructions: CHAIN OF CUSTODY #
Items/Reason
Relinquished by
Date
Received by
Date
Time
Items/Reason
Relinquished By
Date
Received by
Date
Tim
Field inspection and sampling audit form Audit completed by: _______________________________________________________ Audit date: ______________________________________________________________ Field team members: ______________________________________________________ Property under inspection: __________________________________________________
Inspection Item Inspection date and time recorded in field book? Correct IFF and property maps used? Verbal interview conducted completely? Verbal interview recorded in interview form? Property owner’s questions answered? Attic is inspected? Respirator is used to inspect attic? All levels of primary structure are inspected? Field team noted all visible VCI or VCBM? Secondary structures are inspected? Property sketch is completed per SAP, using key? If taken, photographs have scale bars? Appropriate number of dust samples and subsamples collected? Dust subsample locations and areas are appropriate? Dust sampling equipment assembled correctly? Pump flow rate is 2 liters per minute? Dust sample is collected following SOP? Dust sample is recorded correctly on FSDS and in field log book? Dust sample labels are correctly attached to sample and field forms? Chain of custody procedures are followed? Dust samples are stored appropriately? Equipment is decontaminated appropriately? Waste is handled appropriately? Yard is inspected? Property sketch is completed per SAP, using key? Appropriate number of soil samples and subsamples collected? Soil subsample locations are appropriate? Soil samples are composited per SOP? Soil samples are containerized per SOP? Soil sample is recorded correctly on FSDS and in field log book?
In compliance? Notes Yes No
Inspection Item Soil sample labels are correctly attached to sample and field forms? Chain of custody procedures are followed? Soil samples are stored appropriately? Equipment is decontaminated appropriately? Waste is handled appropriately? Gloves are worn for soil sampling? Field notes and forms are legible? Other (please describe):
In compliance? Notes Yes No
Additional notes:
Auditor signature: _____________________________________
Date: _____________
This form has been reviewed with the field team by the field team leader Field team leader signature: _______________________________ Date: ___________ Field team members: ____________________________________ Date: ___________ ____________________________________ Date: ___________
Additional corrective actions taken: Action: ________________________________________________________________ Taken by: ____________________________________________ Date: _____________
Action: ________________________________________________________________ Taken by: ____________________________________________ Date: _____________
Sample Coordinator Checklist
Sampling Crew to Complete This Section
Date: Team #: PDA #:
Parcel Complete? (circle one)
YES
NO
AD Number:
# Of Dust Samples Collected:
Dust Samples Bin # :
# Of Soil Samples Collected:
Soil Samples Bin #:
Sample Coordinator to Complete This Section
Step 1 - Copy Files From the PDA (make sure PDA is powered off and applications are closed) Copy TroyPDA CDB File from PDA to C:\Tape\PDA\PDA# Copy Shape Files from Tape Directory on PDA to C:\Tape\PDA\PDA# Cut and Paste the GPS Correct.SSF file from PDA to C:\Tape\PDA\PDA# Step 2 - Import Files into Scribe Have Crew Folder In Hand – Check for Pink forms and use info to verify imports into Scribe Open Scribe, Go to Import Section and Backup Project to C:\tape\scribe\backups\Tape Sampling_date.bac Scribe Import Data Wizard Parcel Inspection Import
(Parcel Information Data Category) (add new AND update)
Initial When Completed
Primary Building Inspection Import
(Locations/Buildings Data Category)
Secondary Building Inspection Import
(Locations/Buildings Data Category)
Dust Sampling Import
(Air Sampling Data Category) (table name Import PDA Samples Dust)
Dust Area Import
(table name Import PDA Dust Area)
Use Area Import
(Locations/Buildings Data Category) (table name Import PDA Use Area)
Soil Sample Import (Soil Sampling Data Category)
(table name Import PDA Samples Soil)
Create Simple Chain Of Custody Add a new COC
(Special Instructions – Troy Sample Shed – Not for shipping)
Assign Samples to the Simple Chain
(dust & soil on different chains)
Print Simple Chain & deliver to the field crew. They sign & put it in bin. Backup Scribe File, Backup, C:\Tape\Scribe\Backups\Tape Sampling_date
Step 3 – Archive PDA Data Files on the C: drive (c:\tape\pda\PDA# folder should be empty) Highlight all files under c:\tape\pda\pda# and zip them up with the name PDA#_Date.zip Copy the .ZIP file to C:\TAPE\Archived_PDA Post the .ZIP file to the TetraTech Portal Clear off PDA for the next day Step 4 – Copy Field Photos to Computer Copy photos from camera to c:\ Step 5 – Scan Crew Documentation Scan Log Book Pages Scan Parcel Sketches Scan Access Agreement Scan Point of Contact Form Step 6 – Hand Enter Point of Contact Form Enter into Scribe’s Parcel Info Table. Double-Click the AD number and switch to the Contacts tab to enter the point of contact information
Data Issues Sample Coordinator Encountered List Data Mod Forms Added Reason Resolution
Record of Modification
to the Troy Sampling and Quality Assurance Project Plan Field Activities TFO-__ __ __ __ __ (numbered by Data Manager)
Instructions to Requester: Fax to contacts at bottom of form for review and approval. File approved copy with Data Manager at the Troy Field Office (TFO). Data Manager will maintain legible copies in a binder that can be accessed by TFO personnel. If Modification is Temporary for a Single Parcel, Data Manager will scan this and place in parcel’s electronic file.
Project Work Plan/QAPP (check one): o Troy Asbestos Property Evaluation Work Plan o Other (Title and approval date): Site-Specific Guidance/SOP (Number and Revision No.) (check one): o CDM-LIBBY-10, Current Revision (30-point dust sample collection) o CDM-LIBBY-05, Current Revision (30-point soil sample collection) o CDM-LIBBY-06, Current Revision (Visible Vermiculite Estimation) Other (Title, Number/Revision): ______________________________________________________________ Requester: Company: Title: Date:
Tetra Tech EM Inc
Description of Modification (attach additional sheets if necessary; state section and page numbers of each document that are affected by the proposed modification):
Field logbook and page number where Modification is documented (or attach associated correspondence):
Potential Implications of Modification:
Duration of Modification (check one): o Temporary Date(s): BD(s)-___________________
AD-____________________ TT(s)-___________________ Effective Date:
o
Permanent (Proposed Text Modification Section)
Proposed Text Modifications in Associated Document (attach additional sheets if necessary):
Data Quality Indicator (circle one) – Please reference definitions on reverse side for direction on selecting data quality
indicators: Not Applicable Reject Low Bias Estimate High Bias No Bias
Technical Review and Approval: _________________________________ (DEQ Project Manager or designate) EPA Review and Approval: _____________________________________ (USEPA RPM or designate)
Date: Date:
Revised April 29, 2007
DATA QUALITY INDICATOR DEFINITIONS Reject - Samples associated with this modification form are not useable. The conditions outlined in the modification form adversely effect the associated sample to such a degree that the data are not reliable. Low Bias - Samples associated with this modification form are useable, but results are likely to be biased low. The conditions outlined in the modification form suggest that associated sample data are reliable, but estimated low. Estimate - Samples associated with this modification form are useable, but results should be considered approximations. The conditions outlined in the modification form suggest that associated sample data are reliable, but estimates. High Bias - Samples associated with this modification form are useable, but results are likely to be biased high. The conditions outlined in the modification form suggest that associated sample data are reliable, but estimated high. No Bias - Samples associated with this modification form are useable as reported. The conditions outlined in the modification form suggest that associated sample data are reliable as reported.