NYC-WTC_000103702
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TESTWELL LABORATORIES, INC. Bulk Sample Data Chain of Custody Page Eos (
47 Hudson Street, Ossining, N.Y. 10562 TEL (814) 944-2570 FAX (914) 941-4154
Client: Roo VIS. Liz LEMKE cf. Project #: MBO " O24 A)
Project Site: Mice BAJAJ lie tov Honec Date: O “2420 /
Project Address: DD Cte Réit Sy - Me vo YORE, Af Inspector: Ao eS) type bse 4a/
Report to:
% Signature: Lex (TEAK
Name Company “ ) Tel/Vax ae ae
Date Analyzed: q f 26 OL Analyst: (PLM)
Date Analyzed: Analyst: (TEM)
LAB USE ONLY
NYC 9/11 Public Portal Document
FIELD FUNCTIONAL LAYERED? = |FRIABLE = F TYPE OF PLM JEM | -( +)
SAMPLE # | FLOOR AREA | GROUP | ITEM DESCRIPTION Y/N NOB = N COLOR REPAIR NUMBER NUMBER | (- )
he. DEBRIE OV SAF A _
Red -o | 4 SKI LOALLE “/ F Cerf 700 | _
DEBRIS 1 BE71 Cee.
Qahvey a [MTree teen) OCT ° wy | FF | Keene 7602 _
ne ™
_, ~>
ct oT -
a |
\
Li
Revyu, rs a Dari: ‘Timi: IQuIVE sangria): Dare: | Tate: Turnaround Timea: (ann 24HR 48HR 72HR
Cee GI 4 } | 20G 44] OTHER: (must be dated on time)
RELINQUISHED BY (SIGNATURE): "Ipare: | Time: | RECEIVED BY (SIGNATURE): Dare: | Time: Stop at 1st Positive per homogeneous material? Yes or No
Hold for TEM Confirmation? Yes or No
Friable = NYS DOH 198.1 NOB = NYSDOILE 198.4 WHITE: LAB YELLOW: SITE/TECH
COMMENTS:
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NYC-WTC_000103702Source: NYC Law Department, mirrored locally