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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