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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_000175084–000175085
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Scanned page image, NYC-WTC_000175085
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NYC 9/11 Public Portal Document

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ATC ASSOCIATES INC. BATCH NO. 2-rrn % U -J BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION I Client: NYC-BOE 2. Projec! Nam .‘\HERA REINSPECTION 3. Project# 11125-0246 ■4. Project Manager:

2a. Project Atldress:345 Chambers Street. New York, NY 10007 4a. InvestigatortHerant Antonyan

5. Date: 6. Building Name:Stuyvesant 8. Turnaround Time: 9. Comments (Field): _______________ HSIM477I □ stat ~ 24 HRS O 72 HRS OTHER Analyzed all them for fiberglass 7. Sampling .Areas: Entire 10. Time in / Time out: □ 6 HRS 0^*8 HOURS O NORMAL SAMPLE ID MATERIAL LOCATION FLOOR RESULTS H.A.# NUMBER DESCRIPTION NUMBER M477 - ’

Fiberglass Bulk - Settled Dust VP M477 - Settled Dust -3 Fiberglass Bulk - 'M477 - 12^ Fiberglass Bulk - Settled Dust z M477 - Fiberglass Bulk - Settled Dust 41P 'M477 - ••

Fiberglass Bulk - Settled Dust M477 - Fiberglass Bulk - Settled Dust ijp M477 - Fiberglass Bulk - Settled Dust M477 - 5 Fiberglass Bulk - Settled Dust M477 - Fiberglass Bulk - Settled Dust M477 - /o Fiberglass Bulk - Settled Dust CHAI>’ OF CUSTODY 17. Relinquished By; 18. Date: 19. Time: 20. Received By: 21. Dale: 22. Time: 23. Method of Submittal: FIELD WALKW US .MAIL FED-X OTHER

LAB INFORM-ATION 24. Name and Signature; 25. Date; 26. Time; 27. Comnienis (Lab):

24a. .Analyzed 3v:

24b. .Analyzed By: // 24c. QC By:

Fiiename; P:\USERS’iDATA\WP96\WP\FORMS\NY.13 .XLS Fumi NY-13

CONFIDENTIAL, CITY_21MC100_003429913 SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008

NYC-WTC_000175085

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NYC-WTC_000175085Source: NYC Law Department, mirrored locally

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