Chain of Custody Form Instructions for WTC Building Sampling

NYC 9/11 Public Portal Document

SECTION 4. Information for SAMPLE taken inside the building from COMMON AREA

A. Floor Number (ground floor = 1, basement = B)

B. Type of Common Area Stairwell Lobby Hallway Other (describe)

C. Are sample locations (with sample number) shown on map? Y N

D. Is dust visible in this area? Y N

E. Has the area where sample was obhined been cleaned since WTC event? Y N Not Sure If yes; Date of last cleaning ________________________ Who conducted cleaning? ____ Building owner ____ Tenant ____ Asbestos remediation contractor ____ Professional cleaning contractor Private cleaning contractor Name and Contact Information for Contractor:

F. How was this area cleaned? ____ Wet mopping ____ Dusting ____ Sweeping Broom Vacuum HEPA Vacuum Carpet cleaner Curtains Removed Cleaned Cleaned and In Place Rehung

Furniture Removed Cleaned Cleaned and In Place Returned

G. How much dust was present in this area prior to cleaning?

Normal Slight Increase Moderate Increase Large Increase Amount Over Normal Over Normal Over Normal

H. Has there been routine dealing since the WTC collapse? Y N Not Sure

1. If yes, how is this area routinely cleaned? ____ Wet mopping ____ Dusting ____ Sweeping Broom Vacuum HEPA Vacuum Carpet cleaner 4. Information for SAMPLES taken inside the building from COMMON AREAS (continued) J. Were windows near the common area open during WTC collapse? Y N Not Sure If yes, how many were open? K. Were windows near the common area broken during WTC collapse? Y N Not Sure If yes, how many were broken?

18

NYC-WTC_000149544