NYC 9/11 Public Portal Document
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ATC ASSOCIATES INC. BATCH .NO,
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
I Clienr NYC - BOE 0. Projeet Nam A.HERA REINSPECTION 3. Projeet # 19125-0246 a. Project Manager:
2a. Projeet .Adtlre5S:345 Chambers Street. New York, NY 10007 4a. InvesiigatortHerant .Antonyan
5. Date: 6. Building Name:Siuyvesant 8. Turnaround Time: 9. Comments (Field):
/ y HS IM4771 □ STAT 0 24 HRS 0 72 HRS OTHER Analyzed all them for fiberglass
7. Sampling Areas: Entire 10. Time in / Time out:
Q 6 HRS 0 48 HOURS' O NORMAL'
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
M477 - \
/ Fiberglass Bulk- Settled Dust /UJ>
M477 - \
cZ Fiberglass Bulk - Settled Dust 3
M477 -
5 Fiberglass Bulk - Settled Dust
M477 -
Fiberglass Bulk - Settled Dust
M477 -
Fiberglass Bulk - Settled Dust .say-^
M477 -
Fiberglass Bulk - Settled Dust
M477 -
Fiberglass Bulk - Settled Dust 3
M477 -
Fiberglass Bulk - Settled Dust 3
M477 - \
5 4-
Fiberglass Bulk - Settled Dust
M477 -
A *
Fiberglass Bulk - Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. -Received By: 21. Date: 22. Time: 23. Method of
Submittal:
FIELD
/oz^ WALK IN
US MAH.
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time; 27 Comments (Lab):
24a. Analyzed Sv:
24b. Analyzed By:
/
24c. QC By:
pileiiatne; PAUSERS\OaTA'.WP96\WPM’ORMS\NYD3.XLS Foim NY.:3
CONFIDENTIAL, CITY_21MC1OO_OO3429927
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175087
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