NYC-WTC_000103930
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TESTWELL L
“A7 Hudson Street, O:
Client:
eo... o
RATORIES, INC.
ing, N.Y. 10562
ous Lits L fepete LH
THL (914) 944-2570 FAX (914) 94 -4154
Project Site:
LEE AAC bu- jad
Project Address:
Report to:
Vor, A2i0 Yorks.
Name
Date Analyzed:
Company
Analyst: (PLM)
Date Analyzed:
Vin
Analyst: (TEM)
Tel/Fax
Bulk Sample Data Chain of Custody Page.
Project #:
MEO -02544,
tJ
F
5.
o
Date:
G-8) -Y
Inspector: Bene FLL SAMA
Signature:
4 ee
<, LAB USE ONLY:
NYC 9/11 Public Portal Document
FIELD
SAMPLE # | Fi
NCTIONAL
AREA {GROUP | ITEM
DESCRIPTION
LAYERED?
Y/N
FRIABLE = F
NOB =N
TYPE OF
COLOR REPAIR
ol PLM
NUMBER’
NUMBER '| = (= )885
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¢
Date: TIME:
Q)AG-H
RECEIVED BY (SIGNATURE):
D. Boost
DATE:
; OL oy
TIME:
4:50
RELINQUISHED BY (SIGNATI
Dari: TIME:
RECHIVED BY (SIGNATURE):
Date:
TIME:
Friable = NYS DOH 198
COMMENTS:
NOB = NYSDOIT 198.4
ae
Turnaround Time:
OTHER:
8HR
24HR 48HR
Stop at 1st Positive per homogeneous material?’ Yes )or No
Hold for TEM Confirmation? Yes or No
WHITE: LAB
YELLOW: SITE/TECH
72HR
ox dated on time)
—
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000103930Source: NYC Law Department, mirrored locally