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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_000175086–000175087
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Scanned page image, NYC-WTC_000175087
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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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NYC-WTC_000175087Source: NYC Law Department, mirrored locally

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