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Bulk sample data and chain of custody form

Machine-extracted title · confidence 90%

Form documenting bulk sample data and chain of custody for samples analyzed for fiberglass at a NYC school site.

NYC-WTC_000175096–000175097
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Scanned page image, NYC-WTC_000175096
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NYC 9/11 Public Portal Document

Page / of 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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NYC-WTC_000175096Source: NYC Law Department, mirrored locally

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