NYC 9/11 Public Portal Document
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ATC ASSOCIATES INC. BATCH NO. 73
_____ /37/
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1. Client; NYC - BOE ,2. Project Nam AKERA REINSPECTION 3. Project# 19125-0246 4. Project Manager: ANDREAS ANDREOU
2a. Project Addres£;345 Chambers Street, New York, NY 1C007 4a. irvestigator'Herant Antonyan
5. Date; 6. Building Nanie-.Stuyvesant 8. Turnaround Time: 9. Comments (Field);
HS (M477) JOSTAT □ 24 HRS . □ 72 HRS OTHER Analyzed all them for fiberglass
7. Sampling Areas: Entire 10. Time m / Time out:
□ 6 HRS 048 HOURS □NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
M477- Of
/
Fiberglass Bulk - Settled Dust -5// /7. <a.
JX32C1ISV.
M477- 0,2
Fiberglass Bulk - Settled Dust 3
M477- C73
3 Fiberglass Bulk - Settled Dust ?Z’/4ZZ^
/
jM477 -
Fiberglass Bulk - Settled Dust
'M477-Y7S'
Fiberglass Bulk - Settled Dust
M477- C?^
6 Fiberglass Bulk - Settled Dust
M477- g:^
Fiberglass Bulk - Settled Dust
M477 -
/
Fiberglass Bulk - Settled Dust
M477 - 6> 9
9 Fiberglass Bulk - Settled Dust
M477- /O
)O
Fiberglass Bulk - Settled Dust
CHALN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal;
FIELD
/ <1/1 Y 1 WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24, Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a, Analyzed By:J. /I
7~^
24b. Analyzed Bv-
24c. QC By:
Filename: P:\USERS\DATA\WP96\WP\FORMS\NY-l3.XLS Form NY-13
CONFIDENTIAL, CITY_21MC1OO_OO3429843
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175081
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