Document GKaxkq2m8Q68vr1nJnrNMNwv7
RECYCLED
0-0>
AR226-2658
RES EA R C H
. Precise Research. \ Proven Results.
AR226-2658
Analytical Report
Air Sampling Fluorochemical Report
DuPont Washington Works - Air Sampling Program Round 1 xygen Research Report No. L0001277
Testing Laboratory Exygen Research
3058 Research Drive State College, PA 16801
Requester Michael D Aucoin URS Corporation Barley Mill Plaza Building 27 Room 1260 Lancaster Pike and Rt 141 Wilmington, D E \ 19805
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 1 of 7
Summary
Seven solid media samples were received by Centre Analytical Laboratories, Inc. (dba Exygen
Research) (Exygen) from DuPont Corporation. The media represent samples o f air collected on
OVS tubes. Please see Table 1 for a completed listing o f samples received and field air volumes
collected. .
\
The samples were analyzed for Perfluorooctanoic Acid (C8 Acid) using liquid chromatography / mass spectrometry (LCMS). The method employed is entitled "Method o f Analysis for the Determination o f Perfluorooctanoic Acid (PFOA) in OVS Airtubes by LCMS" (James Miller, Exygen Research, February 17, 2003).
The OVS tubes were separated into three fractions for specific fluorochemical analysis. Fraction A consisted o f the filter, backing material and plastic ring. Fraction B contained the first bed o f XAD resin and the PUF backing. Fraction C contained the second bed of XAD resin and PUF backing.. The fractions were extracted with 1 mL of methanol. Perfluorodecanoic Acid (CIO Acid) was added as a surrogate spike to each fraction prior to extraction.
Instrument operating conditions can be found at the beginning o f each analytical run. Raw instrument data is given in Appendix A. Chain-of-custody information can be found in Appendix B.
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 2 of 7
'Results Summary
. Request #
WWK-A-AMS1-E1 A WWK-A-AMS1-E1 B WWK-A-AMS1-E1 C WWK-A-AMS1-E1 (Total)
Air Volume Sampled (L)
1407 1407 1407
f
_.
WWK-A-AMS2-E1 A , WWK-A-AMS2-E1 B
WWK-A-AMS2-E1 C
WWK-A-AMS2-E1 (Total)
1410 1410 1410
. WWK-A-AMS3-E1 A
WWK-A-AMS3-E1 B
WWK-A-EMS3-E1 C
,
WWK-A-EMS3-E1 (Total)
1418 1418 1418
;
i
I
WWK-A-AMS4-E1 A WWK-A-AMS4-E1 B WWK-A-AMS4-E1 C
WWK-A-AMS4-E1 (Total)
:
WWK-A-AMS5-E1 A
WWK-A-AMS5-E1 B
WWK-A-AMS5-E1 C
WWK-A-AMS5-E1 (Total)
.;
..
1397 1397 1397
1418 1418 1418
!
.
WWK-A-AMS6-E1 A WWK-A-AMS6-E1 B WWK-A-AMS6-E1 C
WWK-A AMS6-E1 (Total)
1482 . 1482
1482
1. "<" is defined as not detected at or above the reported level.
C8 Acid (mg/m3)
<0.00007 < 0.00007 <0.00007 <0.00014
0.00007 < 0.00007 < 0.00007 0.0.0007
0.00008 <0.00007 <0.00007 0.00008
< 0.00007 <0.00007 < 0.00007 <0.00014
<0.00007 <0.00007 <0.00007 <0.00014
<0.00007 <0.00007 <0.00007 <0.00014
2. Sample results have.not been corrected for blank results or control spike recoveries.
3. Please note the following descriptions of the OVS sample tube fractions:
Fraction A B C
Fraction Description Frit Extract 1st set beads extract 2nd set beads extract
1' ' '
..
. ' ''
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH
Page 3 of 7
/ 5 /rvi3 4. e j. t<4
0 .0 ^ 0,00
A 0-/4
,' 4 . l4
QC Data
LCS
.
' ' '
Please note: One control sample was spiked with each perfluorooctanoic acid to give a final concentration of 500 ppb. Air was pulled
through the tube at a rate of 1-liter per minute for one hour (480 liters of air). The fractions were separated and analyzed. The
acceptable range for control recovery is 75-125%.
Request # Control 1
C8 Acid (amount spiked - ppb)
500
C8 Acid (amount recovered - ppb)
509
C8 Acid (percent recovery
102
Blanks
Request # WWK-A-AMSFBLK-E1 A WWK-A-AMSFBLK-E1 B WWK-A-AMSFBLK-E1 C
Voi. Of Air (L) 0 0 0
C8 Acid ; (uq/fraction)
<0.10 <0.10 <0.10
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 4 of 7
I. Surrogates
;; a - ^ .
'.
A surrogate spike (CIO Acid) was added to all OVS tubes to give a final concentration of 500 ppb in the extract.
Surrogate spike recoveries are given in the following table. There are no set criteria for surrogate spike
recoveries. Advisory ranges are 75-125%.
.
:.,
,
Sample #
WWK-A-AMSFBLK-E1 A WWK-A-AMSFBLK-E1 B WWK-A-AMSFBLK-E1 C
WWK-A-AMS1-E1 A WWK-A-AMS1-E1 B , WWK-A-AMS1-E1C WWK-A-AMS2-E1 A WWK-A-AMS2-E1 B WWK-A-AMS2-E1 C WWK-A-AMS3-E1 A WWK-A-AMS3-E1 B WWK-A-AMS3-E1 C WWK-A-AMS4-E1 A WWK-A-AMS4-E1 B WWK-A-AMS4-E1 C WWK-A-AMS5-E1 A WWK-A-AMS5-E1 B WWK-A-AMS5-E1 C
} WWK-A-AMS6-E1 A
WWK-A-AMS6-E1 B WWK-A-AMS6-E1 C
Control Spike A Control Spike B Control Spike C
Amount Spiked (ppb)
500 500 500 500 500 500 500 500 500 500 500 500 500 . 500 500 500 500 500 500 500 500 1000* 500 500
Amount Recovered
(ppb) 663 345 393 . 561 384 359 668 423 411 691 417 418 774 384 382 643 358 , 407 825 397 . 442 ; 1196 349 385
Percent Recovery
(% )
133** 69 **
79 112 77 72** 134** : 85 82 : 138 ** 83 ; ; , 84 - 155** 77 76
129 ** . . 72 **
81 ; 165 **
79 88 120 70 ** 77
* The control spike A Fraction was inadvertently spiked twice with surrogate. The surrogate concentration for this sample is therefore 1000 ppb.
** Surrogate recovery outside of advisory range.
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 5 of 7
Calculations
Request #
WWK-A-AMSFBLK-E1 A WWK-A-AMSFBLK-E1 B WWK-A-AMSFBLK-E1 C
WWK-A-AMS1-E1 A .WWK-A-AMS1-E1 B WWK-A-AMS1-E1 C WWK-A-AMS2-E1 A WWK-A-AMS2-E1 B WWK-A-AMS2-E1 C WWK-A-AMS3-E1 A WWK-A-AMS3-E1 B WWK-A-AMS3-E1 C WWK-A-AMS4-E1 A WWK-A-AMS4-E1 B WWK-A-AMS4-E1 C WWK-A-AMS5-E1 A WWK-A-AMS5-E1 B WWK-A-AMS5-E1 C WWK-A-AMS6-E1 A WWK-A-AMS6-E1 B WWK-A-AMS6-E1 C
Control Spike A Control Spike B Control Spike C
Vdl. Of Air
(L) 0 0 0 1407 1407 1407 1410 1410 1410 1418 1418 1418 1397 1397 1397 1418 1418 1418 1482 1482 1482 0 0 0
. C8 Acid (raw-ppb)
<10 <10 <10 <10 <10 <10 101 <10 <10 105 <10 <10 <10 <10 < 10 <10 <10 < 10 <10 <10 <10 509 <10 <10
C8 Acid (ug/fraction)
<0.10 <0.10 <0.10 <0.10 <0.10 <0.10 0.10 <0.10 <0.10 0.11 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 0.51 <0.10 <0.10
C8 Acid (mg/m3)
<0.00007 <0.00007 < 0.00007 0.00007 < 0.00007 <0.00007 0.00008 < 0.00007 < 0.00007 < 0.00007 <0.00007 < 0.00007 <0.00007 < 0.00007 <0.00007 < 0.00007 < 0.00007 <0.00007
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 6 of 7
Example Calculation
:
For sample WWK-A-AMS2-E1A C8 Acid,
L -' \
= [101 ng/ml of C8 Acid x (1 ml) x (1 u g / 1000 ng) x (1 mg / 1000 ug) ] / [(1410 L) x (1 m3 /
1000 L)]
\ V .V;
.V,;.-.. V ; ; '^ _ : \ L \ v
7
..
= , . 0.00007 mg /m 3
Signatures
Paul Connolly, LCMS Team Leader /j
^/John M. Flaherty, Vice President Other Lab Members Contributing to Data James Miller
Date Date
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 7 of 7
Table 1. Login Information / Field Data
Sample ID
WWK-A-AMSFBLK-E1 A WWK-A-AMSFBLK-E1 B WWK-A-AMSFBLK-E1 C
WWK-A-AMS1-E1 A WWK-A-AMS1-E1 B WWK-A-AMS1-E1 C WWK-A-AMS2-E1 A WWK-A-AMS2-E1 B WWK-A-AMS2-E1 C WWK-A-AMS3-E1 A WWK-A-AMS3-E1 B WWK-A-AMS3-E1 C WWK-A-AMS4-E1 A WWK-A-AMS4-E1 B WWK-A-AMS4-E1 C WWK-A-AMS5-E1 A W W K-A AMS5-E1 B WWK-A-AMS5-E1 C WWK-A-AMS6-E1 A WWK-A-AMS6-E1 B W W K-A AMS6-E1 C
Control Spike A Control Spike B Control Spike C
Exygen Lab ID
Date Received Description
L0001277-1 L0001277-2 L0001277-3 L0001277-4 L0001277-5 L0001277-6 L0001277-7 L0001277-8 L0001277-9 L0001277-10 L0001277-11 L0001277-12 L0001277-13 L0001277-14 L0001277-15 L0001277-16 L0001277-17 L0001277-18 L0001277-19 L0001277-20 L0001277-21 L0001277-22 L0001277-23 L0001277-24
11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03 11/7/03
Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract Frit extract 1st set beads extract 2nd set beads extract
Air Volume Sampled (L)
0 0 0 1407 1407 1407 1410 1410 1410 . 1418 1418 1418' 1397 1397 1397 1418 1418 1418 1482 1482 . 1482 0 0 0
I
Login Group: L0001277
Login#:
L601277 > 1,387
:.
Project:
P0000419 : / -
f
Project Title/Type: Analysis o f PFOA in OVS Tubes / ROUTINE
Project Storage:
Submitted By:
Michael D. Aucoin
v ^
| Status:
Unreceived
I Login Type: Started:
Immediate Receipt of Samples T ^.
Date Start: Due Date!
11/7/2003 2:41:35PM 11/21/2003
Received Date: 11/07/2003
Received By:
ROBB, SHAWN
Spread Sample:
Label:
,
"Conform COC Sample: Conform COC: Conform Sample:
Conform Request: '
True" True True
True
, Login Notes: Conform Notes:
. .-
Package PK0001842
Carton
Packages / Containers
Mail Date / Condition
Shipper/ ID
Temp.Control/ Temperai
11/7/2003 10:40:51 PM Package & Contents Uncompromised
FEDEX 8363913020300200
NONE
Direction / Handled Bv
RECEIVED ROBB, SHAWN
Container #
. 1018656 C0018657 C0018658 COO18659 C0018660 C0018661 C0018662 C0018663 C0018664 C0018665 C0018666 C0018667 C0018668 C0018669 C0018670 C0018671 C0018672 C0018673 C0018674 C0018675 C0018676 C0018677 C0018678 C0018679
Gross Weight
7.2 g 7.1 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7-2g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7.2 g 7-2g
EM
Container Type
Other . ; Other
Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other Other
Preservative
, NONE
NONE
NONE
NONE
NONE
NONE .
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
.
NONE
NONE
NONE
NONE
NONE
NONE
. '-
Mfg. Lot
''
. . .
.
Mfg. ID
Miscellaneous Item Key None
11/7/2003 Login.rpt
ICOC
Description
!
0066
Report Version: Oct 23 2003 9:55AM Page 1 of 5
Instance:
R0072027
R0072027
n
1 Sample ID
Matrix
II0001277-0001 , GAS
Fraction OVS Tubes
1.0001277-0002
GAS
OVS Tubes
001277-0003
GAS .
OVS Tubes
t.0001277-0004
GAS
OVS Tubes
L0001277-0005
GAS
OVS Tubes
L0001277-0006
GAS
OVS Tubes
L0001277-0007
GAS
OVS Tubes
LOOM277-0008
GAS , OVS Tubes
LQ001277-00Q9
GAS
OVS Tubes
LOOM277-0010
GAS
OVS Tubes
L0001277-0011
GAS
OVS Tubes
L0001277-0012
GAS
OVS Tubes
LOOM277-0013 ' GAS
OVS Tubes
L0001277-0014 : GAS
OVS Tubes
LOOM277-0015
GAS
OVS Tubes
LOOM277-0016
GAS
, OVS Tubes
L0001277-0M7
GAS
OVS Tubes
L0001277-0018
GAS
OVS Tubes
L0001277-0019
GAS
OVS Tubes
LOOM277-0020
GAS
OVS Tubes
L0001277-0021
GAS
OVS Tubes
LOOM277-0022
GAS
OVS Tubes
LOOM277-0023
GAS
OVS Tubes
LOOM277-0024 .. GAS
OVS Tubes
Samples
Sample
: . V Date Sampled Date Received Date Due
WWK-A-AMSFBLK-E1 A
:
11/07/2003
11/21/2003
WWK-A-AMSFBLK-E1 B
.
11/07/2003
11/21/2003
WWK-A-AMSFBLK-E1 C
11/07/2003 . 11/21/2003
WWK-A-AMS1-E1A
, ..
11/07/2003
11/21/2003
WWK-A-AMS1-E1 B . :
11/07/2003
11/21/2003
VWK-A-AMS1-E1 C WWK-A-AMS2-E1A
`
V : -
:
11/07/2003 11/07/2003
11/21/2003 11/21/2003
WWK-A-AMS2-E1 B
11/07/2003
11/21/2003
WWK-A-AMS2-E1 C
.:
.^
11/07/2003
11/21/2003
WWK-A-AMS3-E1 A
, -
11/07/2003
11/21/2003
WWK-A-AMS3-E1 B
...
11/07/2003
11/21/2003
WWK-A-AMS3-E1 C
.
11/07/2003
11/21/2003
WWK-A-AMS4-E1 A
:
.
11/07/2003
11/21/2003
WWK-A-AMS4-E1 B
.'
11/07/2003
11/21/2003
WWK-A-AMS4-E1 C
-
11/07/2003
11/21/2003
WWK-A-AMS5-E1 A .
.
/
11/07/2003
11/21/2003
WWK-A-AMS5-E1 B
..
11/07/2003
11/21/2003
WWK-A-AMS5-E1 C
- .
11/07/2003
11/21/2003
WWK-A-AMS6-E1 A
;
.
^
11/07/2003
11/21/2003
WWK-A-AMS6-E1 B
^-
11/07/2003
11/21/2003
WWK-A-AMS6-E1 C
:.
11/07/2003
11/21/2003
CONTROL A
:" ; -
11/07/2003
11/21/2003
CONTROLB
.-
11/07/2003
11/21/2003
CONTROLC
11/07/2003
11/21/2003
11/7/2003 Login.rpt
a 0 67
Report Version: Oct 23 2003 9:55AM Page 2 of 5
Instance:
R0072027
R0072027
'1001277-0001
Container ''-0018656/Other/NONE
L0001277-0002
Container C0O186577 Other/NONE
L0001277-0003
Container C0018658/Other/NONE
L0001277-0004
: : Container C0018659/ Other /NONE
L0001277-00Q5
Container C0018660/Other/NONE
L0001277-0006
Container J0018661 /Other/NONE
L D1277-0007
Container C0018662/Other/NONE
L0001277-0008
. Container C0018663/ Other /NONE
L0001277-0009
Container
C0018664 / Other / NONE
L0001277-0010
Container C0018665/Other/NONE
L0001277-0011
Container C0018666/Other/NONE
001277-0012
Container
11/7/2003 Login.rpt
I*
Bottles y Method
y :
;
.y .
Method / ' Method .
:'
Method /
:
Method
Method
Method
; Method
. Method
Method
Method
Method
J U6
Report Version: Oct 23 2003 9:55AM Page 3 of 5
Insstance:
R0072027
R0072027
*^>001277-0013
Container
C0018668 / Other / NONE
:i_0001277-0014
, Container
C0018669/Other/NONE
LQ001277-0015
Container
C0018670 / Other / NONE
L0001277-0016
Container
! C0018671 / Other/NONE
' L0001277-0017
Container
' C0018672/Other/NONE
' L0001277-Q018
Container
'C0018673 / Other / NONE
' 101277-0019
i Container
. C0018674/Other/NONE
L0001277-0020
Container
CO018675 / Other / NONE
L0001277-0021
Container
C0018676 / Other / NONE
L0001277-0022
Container
C0018677 / Other / NONE
L0001277-0023
Container
C0018678/Other/NONE
)001277-0024
Container
11/7/2003 Login.rpt
'
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Method
Method
'
Method
Method
Method
./ -
, .
Method
Method
.
Method
^
Method
, Method
Method
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Report Version: Oct 23 2003 9:55AM Page 4 of 5
U 0 7
Instance:
R0072027
R0072027
C00186797 other / NONE
ogin
I
11/7/2003 Login.rpt
Report Version: Oct 23 2003 9:55AM Page 5 of 5
0 '/'
instance:
R0072027
R0072027
C H A IN O F C U S T O D Y /A N A LY S IS REQUEST F O R M
Exygen Research Sample Receiving * 3 1 1 7 Research Drive State College, PA 1 6 80 1, USA T: 8 1 4 .2 3 1 .8 0 3 2 F: 8 1 4 .2 3 1 .1 5 8 0 exygenresearch.com ' ,
I Page ___ o f
I I
PROJECT I NFQRMATI ON
'
g ANALYSES REQUESTED,!
Client (name & address):
....Afi.A ,A/|N_____ i-- _-- ___ --___
Du/^/V*
- (7^
Phone:
(3 o a )
ILHAh
Fax: ^
Sampler: S 5 0 j \L ft j i-M J Pr A(- /
Project Manager (Name & E-mail Address):
_;_M i k e A ucoia :
'
Project Name:
,A
RO. # : Q u o ta tio n # :
YD
Please fill out this form completely to ensure correct analysis and proper handling of your samples.
SAMPLE A N A L Y S IS ' v
Collection Collection
.03
ExyLIMS# Client Sample identification
Date
Tjme O
WwJ<- A - A a^ P B L K -E I ) Ifda--l1--?-- 0U>33 x
WWU-
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Specify Matrix
1 A;r 1 A:r I A'r 1 kr 1 Aif 1 Air V Ar
Comments
Lfils
Composite Number of Containers
!~ 't C-L.
X X X' X X X
LAB USE ONLY
OF CUSTODY
Relinquished by
^ . .__
j
q /y
Date
Time
l -1I J1i M &6VCj
OTHER INFORMATION
E vO 1
Cooler ID # f\A
Received by
1 . d /M / ...... ... .
LAB USE ONLY
Cooler Temp. (C) aA
Date.
Time
lob* oh
ftjtnh? /ofy
PROJECT REQUIREMENTS
Results D eadline:
Laboratory Report Options: |~1 Sample results only Add case narrative H Add quality control summary CD Add calibration summary
CDAdd raw data
Other_________________ ;
REV 3-02
DuPontftfashington W orks A ir Sam pling Program
S a m p le r(s):
SO, AC RK, LK
FedEx A irb ill #: iJ W IVQ3
Event Number
Event 1
Pump # 669842 669908 669878 , 669831 669769 669865 Hours
0 1 2 3 4
Station & A M S - AMS-2 AMS-3 AMS-4 AMS-5 AMS-6 Minutes 0 60 120 180 240
Exygen iD WWK-A-AMS1-E1 WWK-A-AMS2-E1 WWK-A-AMS3-E1 WWK-A-AMS4-E1 WWK-A-AMS5-E1 WWK-A-AMS6-E1
Hours 5 6 7v 8 9
j. 0 0 7C alibration (pre) M B S tart Tim e i-5'45
KO il
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U12.
A&5?
l.O ll
R-5-to o U .t l
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Minutes
Hours Minutes
30 10 600
360 11 660
420 12 720
480 13 780
540 14 840
Stop Time C alibration (post) Total M inutas --
Mi
IlrbU
'" G h R T o5*n
vV)
Hours
o5 4 4 .
Q tfM 05 3 \
<Dk| 4 " Minutes
15 900
16 960
o t c] 5 ' * i o 0 ,i n
Hours 20
21.-; "
. 4 S 3
I
HJ h
ra 44
l S Minutes
a
,
i
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1200 r7
1260
________ --
17 1020
. 22 3
1320
18 1080
23
1380
19 1140
: -.24 ..
1440
Field Blank: 4 d L
WWK-K-AMSFBLK-E1
yes or no
W eather:
SAFER operational:
C o m m e n ts:
c. o
yes or no
11/4/2003
Page 1 of 1
airdata1.xls
Washington Works No Charge Shipper
Ship To: Exygen Research `3058 Research Drive State College, PA 16801 Attn: Shawn Robb or John Flaherty 814-272-1039
. / .
D ate: 10/27/2003 NCS # : 38-200304715
R o u tin g : FED EX ( SEE ABOVE ACCT) f . O. B.: COLLECT D ate Shipped:
B / L: . , ; . . . ' :
.
Phone Num ber:
Q uantity 1
ProductCode /D escrip tio n Box containing glass sample tubes for analysis
W eight 10
U n its lbs.
- -7 .
7
F re ig h t C lass: TUBES, GLASS, NOI. O rig in a to r: Crane, Alison A Cost Code: 7035-507483-862200 Purchase Order #: Value fo r Customs:
Dim ensions: S h ip F ro m : Stores
S ta tu s :
Phone: 4448
H a za rd o u s S h ip m e n t? No O Yes M SD S S h e e ts R eq u ire d ? No O Yes
M a te ria l Class: Corrosive Flammable
Toxic
Other
Shipping # :
u075
S p e cial In s tru c tio n s : This N-C-S will cover 6 shipments beginning 1 0/30/03.
> Will deliver package to Stores with completed FEDEX Bill. CRG Account Number 2230-5551-6. Weekend samples will be delivered directly to FEDEX. < < < <
Com m ents:
- V ' -" '
''
USA A irb ill
Sender's
ame
jS4 ! "C _j % / 1
Company
.. Address L J c
sS 83^ 3^ 1.^ 02030
^ 3H :m ~W 6>-
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Dept/Roor/Suite/Raom
4a .Express Package Senfce
' Packages up lo isolbs.
/
Delivery commitment may be later in some areas.
R?j FedEx Priority Overnight- { i FedEx Standard Overnight
J r - y Next business morning '
-- ! Ne business afternoon.
P I FedEx First Overnight .
1-- 3 Earliest next business morning
delivery to select locations
i I FedEx 2Day .
[] FedEx Express Saver
Second business day
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CallforConfirmalioo:
---------
n hdEx 20ay Freight
-- Siond business day
Packages over 150lbs.
Delivery commitmentmay be later in some reas.
I I FedEx 3Day Freight
'-- ' Third business day
5 Packaging
F I FedEx Envelope*
ZUFed&Pak* Incides FedExSmail Pak, FedEx - targtfak, and Fttx Sturdy Pak
' Declaredvalue limit S50Q
Other
6 Special Handling
InclutlcCejE^ address in Section 3.
m SATURDAYDeliveiy
. I- I AvaiJableonlyfor.FedExPriority . .Overrrght and FedEx to sdectZIP codes-
r-- HOLD Weekday I__ IatFedExLocation
Not available Ici
.edEx FirstOvernight
Does this shipment contain dangerous gtods? -------------- One box must be checked. -- ----.--
i-- i HOLD Saturday !__ i at FedEx Location
Available only lor FedEx. Priority Overnight
andFedEx2Dayto select locations -
I No
Yes As per attached Shipper's Declaration
Yes
Shipper
Dangerous Goods(including Dry icoVcannotbe shipped in FedEx Bckaging-
r n Dry Ice
I-- I 0rylce,9.Uh
I I Carqt. Aircraft Only
Payment Bill to:
I \% ta in R ecia ~ ~
Enter FedEx Aset. FJo.ir Credit Caul No. below. -- -------------'i
- t. |.'o
Q Recipient.
Q l h i n Party Q ] Credit Card D ^ h / C h e c k
Total Packages
Totaltifciqftfc.:^
Totalleclared Valued
1
' " 1. * _
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. tQ ur liability is limited to S100 u n l e s ^ ^ ^ j f f e a higher value. Setiack tor details.
8 Release Signature 5r5nr<iaurnp4|pMFw'tf'0Uf0fif^'nffS^ 3rR
Total Charges Credit Card Auth.
By signing you authorize us to deliver this shipment without obtaining a `-nature
and agree to indemnify and hold us harmless from any resulting claims.
Questions? Visit our Web site at fedex.com
orca)!1.80t).Go.Fed6i': 800.463.3339.
...
Rev. Dais 10/01Pari !57B12'!S34-20d? FedEx'PRINTED INU.SA WCSL02 . . ,
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