NYC-WTC_000103924
ay a
Project Site:
. e.
TESTWELL LA
47 Hudson Street, Ossining, N.Y. 10562
a ; ® 9
BORATORIES, INC.
Bows, Lith, Lets, £48
u
TEL (914) 944-2570 PAX (914) 941-4154
e e @ e
Bulk Sample Data Chain of Custody Page py) of
MEO -02Z4f
Project #:
Client:
Mutésjior beeiod
G- =o
Date:
Project Address:
Neti Yoke. , Veco Veer
E0012 CLL SANE!
Inspector:
Signature:
Report to:
Name
Date Analyzed:
Date Analyzed:
Company
Analyst: (PLM)
Analyst: (TEM)
| J, Be b eFax
_ :. LAB USE ONLY:
FIELD
SAMPLE #
FLOOR
FUNCTIONAL
GROUP | ITEM DESCRIPTION
LAYERED?
Y/N
PLM | {TEM :
NUMBER | NUMBER °
TYPE OF
REPAIR
FRIABLE = F
NOB =N
COLOR
Wwe
e>
p01 Dus
eA) woe wD
Ry PNNu ey.
Hw
R134
FE |CeA
pay
2210
OPEN
Eel
8 (3S
ie
Xv} Q) —
200
8136
(06
AY
209
aot
(37
vol
Ny] s)
AW
| 8133
[e9
QL \(
8139
[04
ao
Dur 05
~
| £140
{to
Bi
(tt:
U
Qe
| |&2
| Coreen
2
|
N
20
204
—
a
2 |
(Z
Were) V
B12,
U
t
jen__| 8113
Turnaround Time:
Ret
RECEIVED BY (SIGNATURE):
TIME:
LEM
Dari:
Q\-
Dati:
joforfoy
TMi:
q=SD
RELINQUISHED BY (SIGNATURE)
Date: Timi | RECEIVED BY (SIGNATURE):
Darr:
Timi:
Friable = NYS DOI 198.1
COMMENTS:
NOB = NYSDOIT 198.41
VAI ORER OWN
~ n
BHR 24HR 48HR 72HR
OTHER:
(must be dated on time)
Stop at 1st Positive per homogeneous waiaiang 0) or No
Hold for TEM Confirmation? Yes or No
WHITE: LAB YELLOW: SITE/TECH
NYC 9/11 Public Portal Document
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000103924Source: NYC Law Department, mirrored locally