NYC-WTC_000103941
ret weil
47 Hudson Stree
Client:
g, N.Y. 10562
por RATORIES, INC.
TEL (914) 944-2570 FAX (914) 941-4154
OW, Lit) LA eps Lub
® e @
Bulk Sample Data Chain of Custody
MEO - 005,
Project #:
ULE Afton few.
ow
Q- L4 -AS
Date:
Project Site:
Project Address:
Mete opie. A220 Vehe.
AS02738. adie
Inspector:
Report to:
Signature:
N
ame ro
Date Analyzed:
oT Analyst: (PLM)
Date Analyzed:
Analyst: (TEM)
Company
Ut &
/
TelFax
FIELD
NCTIONAL
SAMPLE # | FLOOR
AREA GROUP
ITEM
DESCRIPTION
LAYERED?
Y/N
7. "T_TEM:
FRIABLE = F | .
NUMBER |.
NOB = N COLOR
TYPE OF (6 <_ PLM
REPAIR NUMBER
42 | a5
RS | 7
DY SI OV (Look.
AWD FUCNITCCAE
BRIX
D3hol 4
esos
2.5408) |
OPEV’
LI YOu
| OTL
Quay) d-
U
ERPF
oY
os
of
67
Ve,
MM |—}| SI MY
BETS
68
Eve nite
LOCAL
BAIT
64
Ria 397
|
|
O Pea
Lu i Paw
S/ Be
4 |3?
Cy 2010
2702
L
4
/
8/6
U
30
Ro 2.
2.
_s
v/
N) Vv zn __|8 BS
wZIN
REtgxQNsty
NY
a
v
bo
0 | |
Jaanguwie lV
Time:
(
RECRIVED BY (SIGNATURE):
Dare:
Ret INQUISHED BY (SIGNATURE)
TIMI:
RECEIVED BY (SIGNATURE):
Dati:
Friable = NYS DOH 198
COMMENTS:
NOB = NYSDOH 198.4
Turnaround Time: 8HR 24HR 48HR 72HR
OTHER: (must be dated on time)
Stop at 1st Positive per homogeneous nator) 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_000103941Source: NYC Law Department, mirrored locally