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 IM 3 Project# 14584-0869 4 Project Manager Yiannis Efstathiou
2a Project Address 8 Henry Street, New York,NY 10038 4a Investigator /
3 Date 6 Building Name P S 1 M s Turnaround Time 9. Comments (Field).
□ STAT □ 0 72 HRS 0 OTHER Analyzed all of them for fiberglass
7 Sampling Areas 10 Time in / Tune out
□ 6 HRS □ 48 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
HA# NUMBER DESCRIPTION NUMBER
P.S. lM-8/24/02-
Fiberglass- £>f Settled Dust .X
P.S. lM-8/24/02-
Fiberglass- 6.2- Settled Dust 1
P.S. lM-8/24/02-
Fiberglass- Settled Dust Z/J>
1
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- q 3- Settled Dust
P.S. lM-8/24/02-
Fiberglass- Settled Dust J
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 Tune 20 Received By 21 Date 22 Time 23 Method of
Submittal'
Miwa-Ar ^p/zcn- V US mail
FED-X
OTHER
LAB INFORMATION
24 Name and Signature 25 Date 26 Time 27 Comments (Lab)
24a Analyzed By
24b Analyzed By
24c QC By
Filename P \USERStDATA\WP96\WP\FORMS\NY-13 XLS FonnNY-B
CONFIDENTIAL, CITY_21MC100_003431282
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175497
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