NYC-WTC_000103767
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TESTWELL | LAB BOR ATORIES, INC. Bulk Sample Data Chain of Custody Page. [ of. GL
47 Hudson Street, Ossining, N.Y. 10562 TEL (914) 944-2570 FAX (914) 941-4154
L. LAS LEAL LAE rroject #: MBO - OLB HE,
Project Site: Hit TD (orl bet-TOd pate 47 L2O-L
Project Address: Melt Y ea CEL , Ato VOGEL. Inspector: 406/83. Ez LL SAE
Signature: A Vo
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Report to:
Name Company
Date Analyzed: / of s/c or Analyst: (PLM) Vo , Lo 4
Date Analyzed: Analyst: (TEM)
: FIELD FUNCTIONAL LAYERED? |FRIABLE = F TYPE OF |:
. ¢| SAMPLE # | FLOOR AREA | GROUP | [TEM DESCRIPTION Y/N NOB =N COLOR REPAIR - NUMBER NUMBER 2
1G ‘loq am | |B pemoe | VY | & | Cee all
e] ah | f Quy | | | girs —
| as |W eee d | | g12c ~
ag \ec Pri] 2 ie 8127
Q1 | | usr | 3128
44 | Wy Pussr2} 129
94 19h Pu2l0d| 3 Also
red | | Pazar | | | R12!
: vA [32
(eas [on230h \V A a ee
‘| Ret Boe 4\.39. Tra | RECHIVED BY (SIGNATURE): Dark | Time: Turnaround Time: 8HR Bane , a sted on ire -
Aa »D. Doel lofeifa| 4'-Sd__| OTHER: - mu Ne
Retanqu TURE): ave: y| TIME: | RECEIVED py (signature): =| Dare: | Time: Stop at ist Positive per homogeneous material" Yes ) or
a 4 Hold for TEM Confirmation? Yes or No
3O/C"
y — YELLOW: SITE/TECH
Friable = NYS DOH 198.1 NOK = NYSDOH 198.4 WHITE: LAB
COMMENTS:
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NYC-WTC_000103767Source: NYC Law Department, mirrored locally