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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_000175097
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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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NYC-WTC_000175097Source: NYC Law Department, mirrored locally

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