NYC-WTC_000103943
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47 Hudson Stre
Client:
g, N.Y. 10562
por ATOR INC.
TEL (914) 944-2570 FAX (914) 941-4154
OW, Lit, Le epee, £48
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Bulk Sample Data Chain of Custody Page , of
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Project #:
Project Site:
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Date: G - Uh 7 SG
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Project Address: MU, (ea
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Inspector: E0013 CLL SLL
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Signature:
Report to:
Nume
Date Analyzed:
Date Analyzed:
Company
Analyst: (PLM)
Analyst: (TEM)
Tel/Vax
Yo Yon b
Pree =
EZ PLM
NYC 9/11 Public Portal Document
FIELD
SAMPLE # | FLOOR
- ie
GROUP
ITEM
DESCRIPTION
LAYERED?
Y/N
TYPE OF (
REPAIR
FRIABLE = F
NOB =N
NUMBER
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Date:
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Time: | RECEIVED BY (SIGNATURE):
Darn:
Time:
RELINQUISHED BY (SIGNATL
Dare: Time:
RECEIVED BY (SIGNATURE):
DATE:
TIME:
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 0) or No
Hold for TEM Confirmation? Yes or No
WHITE: LAB YELLOW: SITE/TECH
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000103943Source: NYC Law Department, mirrored locally