NYC-WTC_000103907
TESTWELL LABO
47 Hudson Street, Ossini
Bows Lith Leas, LH}
Client:
ng, N.Y, 10562
ee: y °@ . i Ye
RATORIES, INC.
TEL (914) 944-2570 FAX (914) 941-4154
Bulk Sample Data Chain of Custody Page } of
Project #:
x)
wes,
MEO -02Lf2R,
Project Site:
MiLl EA)
wort feaicwd
Date:
@- 28
-Vf
Project Address: Net?
lowe Ae Veeke.
Report to:
Vara
Inspector E0L/ QF, LL SAA
Signature:
Company Tel/Fax
Analyst: (PLM)
"Name
Date Analyzed: WD
Date Analyzed:
Analyst: (T)
CP eee
+ LAB USE ONLY#3]
FIELD
SAMPLE # | FLOOR
LAYERED?
Y/N
ONAL
GROUP | ITEM DESCRIPTION
TYPE OF
REPAIR
FRIABLE = F
NOB =N COLOR
oO; PIM] =
NUMBER
NUMBER *
or | 55
Dua cn) Fe0e2.
Ani PUEMTVEE
Por
02 |
C4 560
£O32
013 | Vv
Bezum
2.
2
Foy
of |5/
5A
GOR)
os | |
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BOG
FOG
ob |
a)
Por)
07 | 5%
Ruan
|
}
|
leg) VV
2
—
SOT
0%
Yous
ai
sors
a)
52)
APEVED
ax
Bev
—!
Re hey Y,
tO
(a
LIA DOU)
DatR:
TIME:
6 Bou
RES.INQUISHED BY (SIGNATUR!
Q\- ZB-O0
DATE:... RECEIVED BY (SIGNATURE): Date: | Time:
Friable = NYS DOH 1938.1
COMMENTS: Para
NOB = NYSDOH 198.4
Turnaround Time: 8HR
OTHER:
24HR
48HR
Stop at 1st Positive per homogeneous material?" Yes ) or No
Hold for TEM Confirmation? Yes
WHITE: LAB
or No
YELLOW: SITE/TECH
72HR
(must be dated on time)
Co
NYC 9/11 Public Portal Document
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000103907Source: NYC Law Department, mirrored locally