NYC 9/11 Public Portal Document
Page of
ASSOCIATES INC. BATCH NO.
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1. Client: NYC-BOE 2. Project Nam PS 131 M 3. Project # 14584-0875 4. Project Manager: Yiannis Etstathiou
2a. Project Address: 100 Hester Street, New York,NY 4a. Investigator: JI
5. Date: 6. Build ing Name: P.S. 131 M 8. Turnaround Time: 9. Comments (Field): ’
□ stat □ Q 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. 131M-8/22/02-
X/T? •
Fiberglass- /(
P.S. 131M-8/22/02-
Settled Dust /
AJA
Fiberglass-
P.S. 131M-8/22/02-
Settled Dust AJA
Fiberglass- 2 Settled Dust /
P.S. 131M-8/22/02-
7^
Fiberglass-
P.S. 131M-8/22/02-
Settled Dust AJA
/'u
Fiberglass- /
P.S. 131M-8/22/02-
Settled Dust AlA
Fiberglass- Settled Dust
P.S. 131M-8/22/02-
Fiberglass- /JA-
P.S. 131M-8/22/02-
Settled Dust AJA
Fiberglass- Settled Dust
P.S. 131M-8/22/02-
Fiberglass- Settled Dust
P.S. 131M-8/22/02-
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
/I Submittal:
FIELD
/yj CO WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed Sy. - AJ- AL.-. ■ A - -
/I
24b. Analyzed By:
24c. QC By:
Filename. P:MJSERS\DATA\WP96\WP'.FORMStNY-13.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_011530626
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175392
OCR can misread numbers and units. Confirm readings against the page image before using them.