NYC-WTC_000103920
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TESTWELL LABORATORIES, INC. Bulk Sample D Da ta Chain of Custody Page
47 Hudson Strect, Ossining, N.Y. 10562 TEL (914) 944-2570 FAX (914) 941-4154
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MilEnfiore bio Date: G - A -f
4 Voki. y AiPcd VEane. Inspector: 60018 CL Sa
Project Address: Mele
Signature: 4 dere
Client:
Project Site:
Report to:
Company ‘Tel/Fax
Date Analyzed: "Me - eb fa Analyst: (PLM) elfen _-
Date Analyzed: Analyst (TEM)
FIELD FUNCTIONAL LAYERED? |FRIABLE =F TYPE OF
SAMPLE # | FLOOR AREA {GROUP | ITEM DESCRIPTION Y/N NOB = N COLOR REPAIR
8S | 0 ole Bast ov reo, | ww | | Cute
es | P25
cl
{6 124 4280 | (7
G1 | | (e280) |
(
NUMBER
OpEw
eww B/2 6 “i
\
Sj
—lalal_lotal—
24 127 (bucle| 1
| | Bia
Aj |
> Vv V U gr 2 _
35
Dug7 04) LOWE. 4! | & |@HA z> 6/23 a
iE
: ooh a Time: | RECEIVED BY (SIGNATURE): Dare: | Time: Turnaround Time: 8HR 24HR 48HR 72HR
>, - -Of OTHER: on dated on time)
RELINQUISHED BY (SIG Dare Time: | RECEIVED By (SIGNATURE): Date: | Time: Stop at 1st Positive per homogeneous material Yes }or No
qo | ul
a | ema by
INT
Hold for TEM Confirmation? Yes or No
YELLOW: SITE/TECH
Friable = NYS DOI 198.1 NOB = NYSDOH 198.4 j WHITE: LAB
COMMENTS:
\-1 9/11 Public Portal Document _
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NYC-WTC_000103920Source: NYC Law Department, mirrored locally