NYC-WTC_000103905
_ Client:
Report to:
Date Analyzed:
Date Analyzed:
@
TES SWELL LABOR
7 Hudson Street, union p N.Y.
ont
RIES, INC.
10862
TEL (914) 944-2570 FAX (914) 941-4154
@ ®
Bulk Sample Data Chain of Custody Page. = of
Project Site: Mec Ent
Mic.Tor
Date:
Project Address:
Name
9/210)
Analyst: (TEM)
Company
Analyst: (PLM) ia.
Tel/Fax
Project #:
e
3
Inspector:
Signature:
USE:O
‘O
wera
FIELD
SAMPLE #
FLOOR
FUNCTIONAL
GROUP
ITEM
DESCRIPTION
LAYERED?
Y/N
FRIABLE = F
NOB=N COLOR
TYPE OF
REPAIR
: wince
bf
2, |ENe
d
AN
DEEEFLE OV FLOP
Shed Fuente
7
F862
any
22
Lows
f
missing
74S
o3
|
7803
|
om | A
U
P36
a
ea
hb
yA
ee
DATE:
~ ZO
RIVED BY (SIGNATURE):
Time: =| REC
Date:
ah iJ
TIME:
§:304m
RELINQUISHED BY (SIGNATURE):
DATR:
wT
TIME: PRECEIVED BY (SIGNATURE):
Dari:
TIME:
Friable = NYS DOH 198.1
OMMENTS:
NOB = NYSDOH 198.4
Turnaround Time: Com 24HR
OTHER:
e dated on time)
Stop at 1st Positive per homogeneous material
Hold for TEM Confirmation? Yes or No
WHITE: LAB
YELLOW: SITE/TECH
r No
72HR
NYC 9/11 Public Portal Document
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NYC-WTC_000103905Source: NYC Law Department, mirrored locally