Document eLJvJxkp10rwzzgEEg8w4Kry
RECYCLEO
OoJ
AR226-2660
RESEARCH
, Precise Research. Proven Results.
AR226-2660
Analytical Report
Air Sampling Fluorochemical Report
DuPont Washington Works - Air Sampling Program Round 4 Exygen Research Report No. L0001359
( Testing Laboratory \ E x y g e n 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, DE, 19805
j ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH
Page 1 of 7
x 53058 Research Drive
# m s tSatate College, PA 16801, USA
YT: 800.281.3219 F: 814.272.1019 exvgen.com
Summary
Seven solid media samples were received by Centre Analytical Laboratories, Inc. (dba Exygen
Research) (Exygen) from DuPont Corporation. The media represent samples of air collected on
OVS tubes. Please see Table 1 for a completed listing of samples received and field air volumes
collected.
,
c/ . .
The samples were analyzed for Perfluorooctanoic Acid (C8 Acid) using liquid chromatography
/ mass spectrometry (LCMS). The method employed is entitled "Method of Analysis for the
Determination of 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 of the filter, backing material and plastic ring. Fraction B contained the first bed of XAD resin and the PUF backing. Fraction C contained the second bed of XAD resin and PUF backing. Fractions A and B were extracted with 1 mL of methanol. Fraction C ) was not analyzed but saved for possible future analysis. Perfluorodecanoic Acid (CIO Acid) ,was added as a surrogate spike to each fraction prior to extraction. Sample WWK-A-AMS6-E4 was not analyzed as per client request.
Instrument operating conditions can be found at the beginning of each analytical run. Raw
instrument data is given in Appendix A. Chain-of-custody information can be found in
AppendixB.
,
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 2 of 7
[
a. '
'
I Results Summary
Request # .
y WWK-A-AMS1-E4 A
. , WWK-A-AMS1-E4B
,
' WWK-A-AMS1-E4 C
WWK-A-AMS1-E4 (Total)
.
Air Volume Sampled (L)
.
. :: 1432 A -A. ; 1432 1432
C8 Acid (mq/m3)
<0.06.007 < 0.00007
NA <0.00014
.
WWK-A-AMS2-E4 A r WWK-A-AMS2-E4 B
WWK-A-AMS2-E4 C
WWK-A-AMS2-E4 (Total)
;
. .
WWK-A-AMS3-E4 A WWK-A-AMS3-E4 B WWK-A-EMS3-E4 C
WWK-A-EMS3-E4 (Total)
:
: WWK-A-AMS4-E4 A
WWK-A-AMS4-E4 B WWK-A-AMS4-E4 C
WWK-A-AMS4-E4 (Total)
. -
' ';
. WWK-A-AMS5-E4 A ; '
WWK-A-AMS5-E4 B WWK-A-AMS5-E4 C
WWK-A-AMS5-E24(Total)
. ..
1458 1458 1458
1468 1468 1468
1421 1421 . 1421
1435 1435 1435
-'
.
0.0002 <0.00007
NA 0.0002
0.0002 <0.00007
NA 0.0002-
<0.00007 < 0.00007 : NA <0.00014
< 0.00007 <0.00007
NA <0.00014
NA - Not Analyzed. Fraction B was below the quantitation limit, therefore the backup fraction does not require analysis.
1. is defined as not detected at or above the reported level.
2. Sample results hve not been corrected for blank results or control spike recoveries.
3. Please note the following descriptions of the OVS sample tube fractions:
Fraction
Fraction Description
'
A Frit Extract B 1st set beads extract C 2nd set beads extract (not analyzed)
f ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 3 of 7
OC 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 (60 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)
499
C8 Acid (percent recovery
100
Blanks
Request # WWK-A-AMSFBLK-E4 A WWK-A-AMSFBLK-E4 B
Voi. Of Air (L) 0
' '0
C8 Acid (uq/fraction)
<0.10 <0.10
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 4 of 7
Surrogates
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-E4 A WWK-A-AMSFBLK-E4 B
WWK-A-AMS1-E4 A WWK-A-AMS1-E4B WWK-A-AMS2-E4 A WWK-A-AMS2-E4 B WWK-A-AMS3-E4 A WWK-A-AMS3-E4 B WWK-A-AMS4-E4 A WWK-A-AMS4-E4 B WWK-A-AMS5-E4 A WWK-A-AMS5-E4 B
Control Spike A Control Spike B
Amount Spiked (ppb)
500 500 500 500 ... 500 : 500 , 500 500 500 500 500 500 500 500
Amount Recovered Percent Recovery
(ppb)
(%)
931 186*
443 89
946
189* .
465 '
93
; 802
:: 161*
498 100
797 :
159*
474 95
794 : : 159*
471 94 :
804 161*
424 ' 85
889 .
= 178*
412 82
' '
'
/ * Surrogate recovery outside o f advisory range.
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH Page 5 of 7
Calculations
Request #
WWK-A-AMSFBLK-E4 A WWK-A-AMSFBLK-E4 B
WWK-A-AMS1-E4 A WWK-A-AMS1-E4 B
' WWK-A-AMS2-E4 A
WWK-A-MS2-E4 B WWK-A-AMS3-E4 A WWK-A-AMS3-E4 B WWK-A-AMS4-E4 A WWK-A-AMS4-E4 B WWK-A-AMS5-E4 A WWK-A-AMS5-E4 B
Control Spike A Control Spike B
Vol. Of Air (L) 0 0
1432 1432 1458 1458 1468 1468 1421 1421 1435 1435
0 0
C8 Acid (raw-ppb)
<10 <10 <10 <10 311 <10 314 <10 <10 <10 < 10 < 10 499 <10
'
C8 Acid (ug/fraction)
<0.10 <0.10 <0.10 <0.10 0.31 <0.10 0.31 <0.10 <0.10 <0.10 <0.10 <0.10 0.50 <0.10
C8 Acid (mg/m3)
< 0.00007 <0.00007
0.0002 <0.00007
0.0002 <0.00007 <0.00007 < 0.00007 < 0.00007 <0.00007
ALL DATA CONTAINED IN THIS REPORT WAS GENERATED BY EXYGEN RESEARCH
Example Calculation
For sample WWK-A-AMS2-E4 A C8 Acid, . . .
:
: = [311 ng/ml of C8 Acid x (1 ml) x (1 ug / 1000 ng) x (1 mg / 1000 ug) ] / [(1458 L) x (1 m3 / 1000 L)]
0.0002 mg / m3
Signatures
Paul Connolly, LCMS Team Leader 1
ydohn M. Flaherty, Vice^resident 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
Exygen LabID
Date Received Description
WWK-A-AMSFBLK-E4 A L0001359-1
WWK-A-AMSFBLK-E4 B L0001359-2
WWK-A-AMSFBLK-E4 C L0001359-3
WWK-A-AMS1-E4 A
L0001359-4
WWK-A-AMS1-E4 B
L0001359-5
WWK-A-AMS1-E4 C
L0001359-6
WWK-A-AMS2-E4 A
L0001359-7
WWK-A-AMS2-E4B
L0001359-8
WWK-A-AMS2-E4 C
L0001359-9
WWK-A-AMS3-E4 A
L0001359-10
WWK-A-AMS3-E4 B
L.0001359-11
WWK-A-AMS3-E4 C
L0001359-12
WWK-A-AMS4-E4 A
L0001359-13
WWK-A-AMS4-E4 B
L0001359-14
WWK-A-AMS4-E4 C
L0001359-15
c O-
WWK-A-AMS5-E4 A WWK-A AMS5-E4 B
L0001359-16 L0001359-17
WWK-A-AMS5-E4 C
L0001359-18
Control Spike A
L001359-19
Control Spike B
L0001359-20
Control Spike C
L0001359-21
11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03
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
Air Volume Sampled (L)
0 ,0
0 1432 1432 . 1432 1458 1458 1458 1468 1468 1468 1421 . 1421 1421 1435 1435 : 1435
0 0 0
mmr
Table 2. Chain of Custody
Sample ID
WWK-A-AMSFBLK-E4 A WWK-A-AMSFBLK-E4 B WWK-A-AMSFBLK-E4 C
WWK-A-AMS1-E4 A WWK-A-AMS1-E4 B WWK-A-AMS1-E4 C WWK-A-AMS2-E4 A WWK-A-AMS2-E4B WWK-A-AMS2-E4 C WWK-A-AMS3-E4 A WWK-A-AMS3-E4 B WWK-A-AMS3-E4 C WWK-A-AMS4-E4 A WWK-A-AMS4-E4 B WWK-A-AMS4-E4 C WWK-A-AMS5-E4 A WWK-A AMS5-E4 B WWK-A-AMS5-E4 C
Control Spike A Control Spike B Control Spike C
Date Collected
Date Received at Exygen
11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03 11/23/03
NA
na
NA
:
11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03 11/25/03
NA NA NA
Date Extracted by Exygen
12/3/03 12/3/03
NA 12/3/03 12/3/03
NA 12/3/03 12/3/03
NA 12/3/03 12/3/03
NA 12/3/03 12/3/03
NA 12/3/03 12/3/03
NA 12/3/03 12/3/03
NA
Date Analyzed by Exyqen
12/9 -12/10/03 12/9 -12/10/03
NA 12/9 -12/10/03 12/9 -12/10/03
NA 12/9 -12/10/03 12/9-12/10/03
NA 12/9-12/10/03 12/9 -12/10/03
NA 12/9 -12/10/03 12/9 -12/10/03
NA 12/9-12/10/03 12/9 -12/10/03
NA 12/9-12/10/03 12/9 -12/10/03
NA
Login Group: L0001359
'"Login#:'
Project:
Project Storage:
Submitted By:
Status:
;
Login Type:
L0001359 > 1,469
P0000419
;; ^
^ ;;
Michael D. Aucoin
Unreceived
Immediate Receipt of Samples
;
v.V' >:
v
.
T ,
Conform C CSample: True
Conform COC: :True
Conform Sample:
' True
Conform Request:
True
'
Started: Date Start:
Due Date:
. Received Date: Received By:
T 11/25/2003 11:21:15AM
12/09/2003
11/25/2003 AMMERMAN, MARK
. ; T:
;
' :
; . A + k frA.cs. ;v
Spread Sample:
.
Label:
Project Title/Type: Analysis of PFOA in OVS Tubes / ROUTINE
Login Notes: Conform Notes: As per Mike Aucoin, sample WWK-A-AMS6-4 is cancelled. MSA 11/25/03
Package Carton PK0001939
Packages / Containers : ; ;
Mail Date/Condition
Shipper/_ID
Temp. Control/ Temperat
11/25/2003 10:50:59AM Package & Contents Uncompromised
FEDEX 8363913019820200
RT
Direction / Handled By
. RECEIVED AMMERMAN, MARK
container#
C0020181 C0020182 C0020183 C0020184 C0020185 C0020186 C0020187 C0020188 C0020189 C0020190 C0020191 C0020192 C0020193 C0020194 C0020195 C0020196 C0020197 C0020198 C0020199 C0020200 C0020201
Gross Weight
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
7.1 g
7.1 g
7.1 g
7.2 g
7.2 g
7.2 g
7.1g -
7.1 g 7.1 g
.
7.1g
7.1g
7.1 g
EM
Container Type
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
Mfg. Lot
Mfg. ID
Miscellaneous Item Key
\ None
11/25/2003 Login.rpt
Description
054
Report Version: Nov 13 2003 4:51PM Page 1 of 4
instance:
R0074478
R0074478
Samples
\ Sample ID /Q001359-0001
Matrix GAS
Fraction OVS Tubes
Sample
;
WWK-A-AMSFBLK-E4 A
\
Date Sampled Date Received . . 11/25/2003
Date Due 12/09/2003
001359-0002
GAS nAQ
OVSTubes OVS Tubes
WWK-A-AMSFBLK-E4 B
. ;-
11/25/2003 11/25/2003
12/09/2003 12/09/2003
L0001359-0004
GAS
OVS Tubes WWK-A-AMS1-E4 A
11/25/2003
12/09/2003
L0001359-0005
GAS
OVS Tubes WWK-A-AMS1-E4 B
-
..
.-
11/25/2003
12/09/2003
beo6-i359-oee6~~` GAS
OVS Tubes -WWK-A-AMS I-E4-G-- .
11/25/2003
12/09/2003
L0001359-0007
GAS
OVS Tubes WWK-A-AMS2-E4 A
.;/ -
- - 11/25/2003
12/09/2003
L0001359-0008
GAS
OVS Tubes WWK-A-AMS2-E4 B
.
11/25/2003
12/09/2003
L-eee59=eee9- ' , GAS
OVS Tubes ' -WWKWWMS2-E4-G- . . . :
11/25/2003
12/09/2003
L0001359-0010
GAS
OVS Tubes WWK-A-AMS3-E4A
11/25/2003
12/09/2003
L0001359-0011
GAS
OVS Tubes WWK-A-AMS3-E4 B
. .. .
''
11/25/2003
12/09/2003
-10004350-0012
GAS
OVSTubes WWK-A-AMS3-C4 6 ~
' . : .
11/25/2003
12/09/2003
L0001359-0013
GAS
OVS Tubes WWK-A-AMS4-E4 A
.
11/25/2003
12/09/2003
L0001359-0014
GAS
OVSTubes WWK-A-AMS4-E4 B
11/25/2003
12/09/2003
fc90Q1359-0015-
GAS , OVSTubes
WWK A-AMS4 C4 --
;
.-
11/25/2003
12/09/2003
L0001359-0016
GAS
OVSTubes WWK-A-AMS5-E4 A '
..
...
11/25/2003
12/09/2003
L0001359-0017
GAS
OVSTubes WWK-A-AMS5-E4 B
;'
11/25/2003
12/09/2003
-teeM359=eOt8^ GAS
OVSTubes -WWK-A-AM30-E4-C
.'
11/25/2003
12/09/2003
L0001359-0019
GAS
OVSTubes Control 1 A
...
11/25/2003
12/09/2003
L0001359-0020
GAS
OVSTubes Control 1 B
.
11/25/2003
12/09/2003
GAS
OVS Tubes --Control 1 G--
11/25/2003
12/09/2003
I
11/25/2003 Login.rpt
UUbD
Report Version: Nov 13 2003 4:51PM Page 2 of 4
Instance:
R0074478
R0074478
n
/ ''
Q001359-0001
'. ; ;
" -; ;.=
Container
C0020181 / Other/NONE
^
.v :
^
Bottles
'
Method
.
L0001359-0002
Container
0 0 0 2 0 1 8 2 /O ther/N O N E
L00013 59 -0 0 03
Container
C0020183 / Other / NONE
-'v Method
' ' \;
'
' ''
.
.....
,
v V,:. :- v Method
LQ001359-0004
Container
0 0 0 2 0 1 8 4 /O ther/N O N E
- ---V';' ; .y . ' y. .' v" 'y
Method
L0001359-0005
Container
0 0 0 2 0 1 8 5 /O ther/N O N E
y :y ': y y V / y y ..
-; ' ' '
\
y y ;-'V,yy
Method
;>' . y : .**
L0001359-0006
Container
I '0020186/Other/NONE
L0001359-0007
: Container
00020187/O th e r/N O N E
.
.y V '
' ''
\
y . . V y y V ; '..
Method
.
' . ' ' . -
. . " ' Method
:
L0001359-0008
Container
C0020188/Other/NONE
,
. Method
-
L0001359-0009
Container
00020189/O th e r/N O N E
... . V
. Method
'' ' '
. '. '
L0001359-0010
Container
00020190/Other/NONE
Method
:\
L0001359-0011
Container
C0020191 /O th er/N O N E
-
Method
.
[901359-0012 Container
11/25/2003 Login.rpt
Method
J U5 6
Report Version: Nov 13 2003 4:51PM Page 3 of 4
Instance:
R0074478
R0074478
C0020192/ Other/NONE
' 0001359-0013
Container
^0020193 / Other / NONE
' .
L0001359-0014
Container
C0020194/Other/NONE .
' '
L0001359-0015
Container
C002019 5 /O th er/N O N E
^
L0001359-0016
Container
C0020196/Other/NONE
L0001359-0017
Container
00020197/Other/NONE :
L0001359-0018
Container
^ 0 0 0 2 0 1 9 8 /O th e r/N O N E
,
Lu001359-0019 - _'
Container
C0020199/Other/NONE
'
L0001359-0020
Container
C0020200 / Other / NONE
'
L0001359-0021
Container
C0020201 /O th er/N O N E
.
;
.
.^
Method
/.
-.v.-
v ; Method
\ . .'.V '.
-
.... :
:
V:
Method
^
' \
-
Method
v a-
^
Method
\,
. Method
..
.... : ' .
Method
Method
Method
I
11/25/2003 Login.rpt
j Ub7 ' '
Report Version: Nov 13 2003 4:51PM
Page 4 of 4
Instance:
R0074478
R0074478
PROJECT INFORMATION Client (name & address):
CHAIN OF CUSTODY/ANALYSIS REQUEST FORM
Exygen Research Sample Receiving 3117 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
Page
of
ANALYSES REQUESTED
Project Manager (Name & E-mail Address):
.................................
Phone: Fax: Sampler:
I
Project Nam e:,
R^OO # ^ Quotation #:
\O ^\
Please fill out this form com pletely to ensure correct analysis and proper handling of your samples.
5
'O '}
J
M PLE A N A LYSIS:ExyLIMS# Client Sample Identification
Collection Collection
Date
Time
JnOj O
o Q.
uEo
o.E
jcc3a +iocs
Z U Specify Matrix
lipH)o-!-trAlB
He
v y /o v -e ft-
ole.\3. *
J S C .
uNAyOVs- f t - f V S
Prv(
\ j m r ft-IV m S
Qin\
.file . .B & n
E
LAB USE ONLY
Comments e_\& g )\tw x y --
77*7*
"AY ' U-6f nftf/r j-
CHAIN OF CUSTODY
Relinquished by
77' ----:-------- H - ---- - ---- :
M id: -K ^udcU Lk'
(P .
-
Date
Time
----
n Af 03 9 % 3 0
Cooler ID # _ _ yi_ o jjA s-- Cooler Temp. (C)
Received by
Date
Time
1
O ff
J / -r: P
-- .--- --
---- -- .---------
1/ /, //A s A ?
e<s2& /* r
OTHER INFORM ATION
PvRxA
LAB USE ONLY
o
U_
-y
*
PROJECT REQUIREMENTS Results Deadline:
Laboratory Report Options:
|~~l Sample results o n ly .
I I Add case narrative
Add quality control summary I I Add calibration summary I I Add raw data o th e r
REV. 3-02
Sampler(s): LK, REK
DuPont Washington Works Air Sampling Program
FedEx Airbill #: 836391301982
Event Number
Event 4
669842 669908 669878 669901 669769 669865 Hours
0 1 2 3 4
MS-1
A M S -2 A M S -3 A M S -4 A M S -5 A M S -6 Minutes
0, 60 120 180 240
WWK-A-AMS1-E4 WWK-A-AMS2-E4 WWK-A-AMS3-E4 WWK-A-AMS4-E4 WWK-A-AMS5-E4 WWK-A-AMS6-4
Hours 5 6 7 .8
.9
i.o :8 1.029 1.028 1.021 1.015 1.014 Minuts 300 360 420 480 540
23-Jjov 23-Nov 23-Nov 23-Nov 23-Nov 23-Nov Hours
10 11 12 13 14
6 35 6:30 6:30 6:44 6:09 '6:56 Minutes 600 660 720 780 840
24-Nov -- 6P 12 24-Nov 6:22 24-Nov 6:22 24-Nov 6:34 24-Nov 6:01 24-Nov 6:45 Hours Minutes
15 900 16 960 17 1020 18 1080 19 1140
Field Blank: yes ]WWK-K-AMSFBLK-E4 yes or no
Weather: 11/23 =
48 degrees and clear, expect temperature to go to upper 60's.
11/24 =
45 degrees and clear, expect rain and drop in temperature to 30's.
1.008 1.022 0.9668 0.9892
*
Hours 20 21 22 . 23 24
? 1428 1434 1433 1431 1434 880
Minutes 1200 1260 1320 1380 1440
--------- ' . _ J >
SAFER operational
yes yes or no
Comments: Total minutes column is the reading from the monitor counter.
* The pump for AMS6 was not running when we collected the sample and the counter only read 880 minutes. We can not get the AMS6 pump to run for Post Calibration even plugged into building outlet. We will replace pump before next test.
Ub9
11/24/03
Page 1 of 2
airdataevent4
Another Calculation
1442 94 146-, J 1468 825 1422 2709 1437,0114 #VAi.U0
U
11/25/2003
Page 2 of 2
airdataevent4
Fed
USA A ir b ill
Express
,
t From
\
; P a t e \ ,^ , 1 '
Sender's . Name
!"
FedEx
&3t,3cil3 0 1 ci3Tracking
Number
Phone I \ ':< l y A \ M ,
Company
Address
DapUFloor/Suite/Room
State .
ZIP
2 Y o u r In te rn a l B illin g R e fe re n ce
--
\
r
3 To
Recipient's Name
; 'V.... ' V - ': , '
? X'
1i .: Comoanv - . t .. .. >v
\ 1
Address
: "T
To`'HOLD" al FedExlocaimn, print FedExaddress.
Address
---V- `
V.
VWy ,, : '
.. . i "P h on e
`
i'" ) ? V ;
' ''S i) ' ;
> 1 j
V
\
' .
^ i'X '
-^
V, . We cannotdaByer to P.0, boxesor P.0, ZIP codes.
' ... Dept/Floor/Sulte/Room
1 ! IU
4 a E xp re ss P a cka g e S e rv ic e
Packages up to 150 lbs.
'Z s iis s s r *
Oeiiverycommitment maybelaterinsamB areas.
a & j- * '- - D = 5
deliverylo select locations
I | FedEx 2Day l_____ Secondbusinessday
I I FedEx Express Saver * - J Thirdbusi^X ' T
r ~ ~ . FedExEnvelope rate not auailable.Wnimnmcharne-Dne,on,, n[l
4b Express Freight Servics
i ! FedEx 1Day Freight* -- - Next businessday *Call (or Confirmation: _
P I FedEx 2Day Freight
1-- 1 Secondbusinessday
_ Packages over 150lbs. Deliverycommitment maybe latarin some areas.
F I PecJEx 30av Freight 1-- 1 Third businessday
5 Packaging i FedEx Envelope
CDFedEx Pak*
IncludesFedExSmall Pak, FedEx '
____ large Pak. andFedExSturdyPak
' ` Declaredvalue limit S500 Other
6 S p e c ia l H a n d lin g
(--, SATURDAY Delivery
Indude FsdLt aiidrec in .Section 3. ________.
3NouS* Location
FedExfaaveCrnf.ig.ht '
Does this shipment contain dangerous goods?
I-- i HOLD Saturday
I-- I at FedEx Location . Available onlyfor FedEx Priority Overnight and FedEx20ay to
:- - y ----- --- . One box must be c h e c iia d .--------------------_
select locations
r>iiNo rnYes ' r~i Yes
11
,L_P-
. I__ I As per attached ` I__ I Shipp_er_'s_C_eclaration
*
.Shipper's Declaration
not required
.Dangerous Goods(includingDryIce) cannot be shippedrr.FedExpackaging, i
I 1 Drylce I-- I Dryice.5, UN 1W5-
D Cargo Aircraft .Only -
-kg .'
7 ^ P a y m e n t B illtO .--------- Enter FedEx Acer. No. or Credit Card No. bek
[ ~ | Qhtaiiyflecip.
Sender '.
flR ecip ie n t
H T h ird Party ' M ' -7 T * T ' r ^ ctNo' '
' nvibibiiieSd!c,ion
. ..
U redtt Card
Cash/Check
U6 !
Git*
L
' .-V " '\ .
State
' f -if- j.
; i C ZIP
\ V. T , . \ 1 ; V; \
S 3 b 3 5 1 3 0 1 *5 0 2
% .
Total Packages
Total Weght
Total Declared Value-
' 1 --
;/--
'
.00
*Our liability is limited to SIIBunie' you declare a hhiigghheerr value. See back for details.
8 R e le a s e S ig n a t u r e Signiotforize deliverywithoutobtainingsignature.
' t i y -
fi
- By signing.you authorize us to dver this shipment withbut.o' btainina a sitture
and agree to indemnify ant) hoi's harmiess from anyresuiting claims.-
Q uestions? Visit di Web site at fedex com or call I.SOO.Go.FedEx' 60CF3.3339. FsvOaie 10/0 Pa^t i 15712i^ I--2ffi1FedExPRINTEDINUS WCSi.02
*? ! !
Total Charges . Credit CardAuth..
