NYC 9/11 Public Portal Document
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TC ASSOCIATES INC. BATCH NO.
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
I Client NYC - BOE 2. Project Nam PS IM :3 Project# 14584-0869 4 Project Manager Yiannis Efstathiou
2a Project Address 8 Henry Street, New York,NY 10038 4a Investigator /
5 Dale 6 Building Name P S 1 M 8 T'umaround Time 9. Comments (Field):
7 Sampling Areas
□ STAT 0 □ 72 HRS □ OTHER Analyzed all of them for fiberglass
10 Time in / Time out
□ 6 HRS 048 HOURS I I NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
P.S. lM-S/24/02-
Fiberglass- £if Settled Dust
P.S. lM-8/24/02-
Fiberglass- e>2~- Settled Dust 1
P.S. lM-8/24/02-
Fiberglass- Settled Dust
P.S. lM-8/24/02-
Fiberglass- Settled Dust
P.S. lM-8/24/02-
Fiberglass- Settled Dust 2.
P.S. lM-8/24/02-
Fiberglass- Settled Dust
P.S. lM-8/24/02- c2/3
Fiberglass- Settled Dust
P.S. lM-8/24/02-
Fiberglass-
P.S. lM-8/24/02-
Settled Dust J -nu<x-
Fiberglass- Settled Dust >4-
P.S. lM-8/24/02-
Fiberglass- Settled Dust
CHAIN OF CUSTODY Please call Project Manager 646-772-1155
17. Relinquished By 18 Date. 19. Time 20 Received By: 21. Date 22 Time 23 Method of
Submittal'
n/mid/-/jiC., >
' ys-MAit..
FED-X
OTHER
LAB INFORMATION
24 Name and Signature 25 Date 26. Time. 27 Comments (Lab)
24a Analyzed By W/O V /( M\
24h Ana1v7.ed Rv
24c QC By
Filename P \USERS\DATA\WP96\WPkFORMS\NY-!3 XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_003430090
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175096
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