NYC 9/11 Public Portal Document
Page of
ATC ASSOCIATES INC.
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
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Dale 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 048 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A# NUMBER DESCRIPTION NUMBER
P.S. lM-8/24/02-
Fiberglass- Settled Dust 5
P.S. lM-8/24/02-
Fiberglass- Settled Dust
P.S. lM-8/24/02- 3
J
Fiberglass- Settled Dust I
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 Date 22 Time 23 Method of
Submittal
/ FIELD
'USTvIAIL
FED-X
OTHER
LAB INFORMATION
24 Name and Signature 25 Date 26 Time 27 Comments (Lab)
24a Analyzed By A'/ ///-TzY^
24b Analyzed By
24c QCBy
Filmamc P 'USERStDATA\WP96\WP\PORMS\NY-l3 XLS ForniNY-B
CONFIDENTIAL, CITY_21MC100_003431283
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175498
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