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 BOE 2 Project Nam PS 131 M 3 Project# 14384 0873 4 Project Manager Yiannis Elstathiou
2a Project Address 100 Hester Street New York NY 4a Investigator
C 7
3 Date 6 Build ng Name P il 131 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 QdS HOURS 0 NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
HA# NUMBER DESCRIPTION NUMBER
P S 131M 8/22/02
/
Fiberglass /( Settled Dust
PS 131M-8/22/02
Fiberglass
PS 131M-8/22/02
Settled Dust AJA
Fiberglass 3 Settled Dust /
YA
P S 131M 8/22/02
7^
Fiberglass-
PS 131M-8/22/02-
Settled Dust /
AJA
Fiberglass
PS 131M-8/22/02-
/ Settled Dust /
AJA
Fiberglass-
PS 131M-8/22/02-
Settled Dust si, AJA
Fiberglass-
PS 131M-8/22/02-
Settled Dust AJA
Fiberglass- Settled Dust
PS 131M-8/22/02
Fiberglass- Settled Dust
PS 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
/S'J cl WALK IN
US MAIL
FED X
OTHER
LAB INFORMATION
24 Name and Signature ^5 Dale 26 Time 27 Comments (Lab)
24a Analyzed By /I
24b Analyzed By
24c QC By
F lenam P \USERS\DATA\WP96\WP\FORMS\NY IJ XLS Form NY 13
CONFIDENTIAL, CITY_21MC100_003430994
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175425
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