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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_000175080–000175081
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Scanned page image, NYC-WTC_000175081
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NYC 9/11 Public Portal Document

Page of 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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NYC-WTC_000175081Source: NYC Law Department, mirrored locally

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