NYC 9/11 Public Portal Document
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ATC ASSOCIATES INC BATCH NO
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1 Client NYC BOh 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 Jimmy Ghoy ■y ,
5 Date 6 Building Name PS 131 M
Sampling Areas
8 Turnaround Time
□ stat □ □ 72 HRS □ OTHER
9 Comments (Field)
Analyzed all of them for fiberglass
10 Time in / Time out
□ 6 HRS 048 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
HA# NUMBER DESCRIPTION NUMBER
PS 131M 8/22/02-
/6. 4-55
Fiberglass- <9/
P S I31M 8/22/02
Settled Dust a /a
Fiberglass 9 Settled Dust
PS 131M 8/22/02-
Fiberglass-
PS 131M-8/22/02
Settled Dust AJA
Fiberglass- Settled Dust
PS 131M-8/22/02-
3
Fiberglass-
PS 131M 8/22/02
Settled Dust AAA
Fiberglass Settled Dust 3
PS I31M 8/22/02
Fiberglass Settled Dust 4Z6
P S 131M 8/22/02-
Fiberglass-
P S 131M 8/22/02
Settled Dust AJL
Fiberglass-
PS 131M-8/22/02
Settled Dust AJA
Fiberglass- Settled Dust
/
ajA
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 ot
Submiltal
FIELD
WALK. IN
tZ US MAIL
FED X
OTHER
LAB INFORMATION
24 Name and Signature 25 Date 26 Time 27 Comments (Lab)
24a Analyzed By /7
24b Analyzed By
24c QCBy
Flcnamc P 1USERS'DATA\WP961WP\FORMS\NY 13\LS Fonn VY 13
CONFIDENTIAL, CITY_21MC100_003430993
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175424
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