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Settled dust bulk sample chain of custody form

Machine-extracted title · confidence 85%

Confidential chain of custody form and laboratory results record for settled dust bulk samples collected at a NYC school site.

NYC-WTC_000175076–000175077
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Scanned page image, NYC-WTC_000175077
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NYC 9/11 Public Portal Document ATC ASSOCIATES INC. BATCH NO. Loe ES. BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION {. Chenu NYC - BOE 2. Project Nam AHERA REINSPECTION 3. Project # 19125-0246 4. Project Manager: ANDREAS ANDREOU 2a: Project Address.345 Chambers Street, New York, NY 10007 4a. Investigator: Herant Antonyan 5. Date: 6. Building Name:Stuyvesant, ]8. Turnaround Time: 9. Comments (Field): Hs (M477)_|([]sTaT [7] 24HRS [(] 72HRS [XJ] OTHER | Analyzed all them for fiberglass 72,//9/o/ 7. Sampling Areas: Entire . + 10. Time in / Time out: Clours [Jassours [[] normal Aye SAMPLE ID MATERIAL LOCATION FLOOR RESULTS HAF NUMBER DESCRIPTION NUMBER M477 - o/ . No AIBERG. / Fiberglass Bulk - Settled Dust aad floor Cafeteria aa PUFA i DETECT M477- O2 . | ber Gym (Aax. Gym of Fiberglass Bulk- {Settled Dust {27 ot fe Ff (+ ole ) 5 M477- ©3 j ] 3 Fiberglass Bulk - Settled Dust Lo side . a Aoriam L M477- O44 . i , &pog 4 Fiberglass Bulk - Settled Dust L£ st fpec lobby . £ M477 - OS” ; a Fiberglass Bulk - Settled Dust of nd floor ACE Xf M477 - O06 fie G Fiberglass Bulk - Settled Dust : Ih o ; “a a J M477 - OF | *~ |riberglass Buk- | |Settled Dust: ath freer fa heey. 3 2 M477 - OF keom 935 Seely 9 Fiberglass Bulk- |Settled Dust- M477- 09 oe Room B40 Word 7 lei led Dust. | | 3 , Fiberglass Bulk - Sett Cc ust . M477 - . / / d 10 foom FOl Fast a Fiberglass Bulk - | Settled Dust Vv CHAIN OF CUSTODY 17. Relinquished By: 18. Date:!}19. Time: 20. Received By: 21. Date: 22. Time: 23, Method of Submittal: ; \f c , FIELD US MAIL FED-X OTHER LAB INFORMATION 24. Name and Signature: 25. Date:/26. Time: 27, Comments (Lab): 24a. Analyzed By: 4 ZL Liver fo to Y2/ /G A (ce (L7 24b. Analyzed By: ; 24c. QC By: Filename: P-AUSERS\DATA\WP96\WP\FORMSINY-13.XLS Form NY-13 CONFIDENTIAL, CITY_21MC100_003429781 SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008 NYC-WTC_000175077

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NYC-WTC_000175077Source: NYC Law Department, mirrored locally

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