NYC 9/11 Public Portal Document
Page of
ATC ASSOCIATES INC. BATCH NO. a .. -7^ .-7
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1 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 Date 6 Building Name P.S 1 M 8 Turnaround Time 9. Comments (Field):
□ STAT □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass
7 Sampling Areas 10 Time in / Time out
□ 6 HRS □ 48 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
P.S. lM-8/24/02-
Fiberglass- Settled Dust s'
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
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
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
CHAIN OF CUSTODY Please call Project Manager 646-772-1155'
17 Relinquished By: 18 Date- 19 Time 20 Received By 21. Dale 22 Time 23 Method of
Submittal.
FIELD
■ USTiUlL
FED-X
OTHER
LAB INFORMATION
24 Name and Signature. 25 Date 26 Time 27 Comments (Lab)
24a Analyzed By A-Y —
//
I
24b Analyzed By
24c QC By
Filename P \USERS\DATA\WP96\WPVFORMS\NY.13 XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_003430091
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175097
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