NYC-WTC_000103706
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TESTWELL LABORATORIES, INC. Bulk Sample Data Chain of Custody Page. of
47 Hudson Street, Ossining, N.Y. 10562 TEL (914) 944-2570 PAX (914) 941-4154
B Qs Leu LEABE, | Project #: MBL O2SMES —
Project Site: Mice EA MIRA Ha TOAM 407 Be 2 pate; /O-0 “ € aA
Project Address: ake, CH ULC EI BY, A ted Ke OE aa AG Inspector:-L > Er Sf GEYSLEA AOL
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Signature:
Client:
Report to:
Name | Company QoQ. * ‘Tel/Fax
Date Analyzed: ___/ O ] oO} [O 2—Analyst: (PLM) ~ f
Date Analyzed: / Analyst: (TEM)
LAB USE ONLY
FIELD FUNCTIONAL LAYERED? |FRIABLE = F TYPE OF PLM J TEM ( +).
SAMPLE # | FLOOR AREA GROUP | ITEM DESCRIPTION Y/N NOB = N COLOR REPAIR NUMBER NUMBER (-)
JO -07 <x WAC -3 1 DOT O° OMIT RS [= beg fcte|. 7 } cA. —_—
we} ou {ou D “ nw | € | kee. VISE —
Dari: Time: | RECEIVED BY (SIGNATURE):
H-rologl- Bio
RELINQUISHED BY (SIGNATURE): Dati: Timi: | RECEIVED BY (SIGNATURE): DaTE: Time:
OTHER: (must be dated on time)
Stop at 1st Positive per homogeneous material? Yes or No
Hold for TEM Conlirmation? Yes or No
Friable = NYS DOH 198.1 NOB = NYSDOHEL 198.4 WHITE: LAB YELLOW: SITE/TECH
COMMENTS:
DenAof Finns ra Turnaround Timo: BHR, Vs 48HR 72HR
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NYC 9/11 Public Portal Document
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NYC-WTC_000103706Source: NYC Law Department, mirrored locally