NYC 9/11 Public Portal Document
Page of
re ASSOCIATES INC. BATCH NO.
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
I. Client: NYC - BOE 2 Project Nam AHERA REINSPECTION ,3- Project# 145S4-0823 4. Project Manager: Yianns Efstatiiioii
2a. Project Address.292 Greenwich street, New York, NY 10007 4a. lnvestigator:Chacko Mathew
5. Date: 0. Building Namt.PS234M 8. Turnaround Time; 9. Comments (Field);
□ STAT 0 24 HRS 0 72 HRS 0 OTHER Analyzed all of them lor fiberglass
7. Sampling Areas: 10. Time in Time out:
O 6 HRS 048 HOURS 0 NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
PS234M-3/23/02- -S-o.^nr)
31 Fiberglass- 'i’l Settled Dust
PS234M-3/23/02-
3^ Fiberglass- A Settled Dust
PS234M-3/23/02-
3J Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
PS234M-3/23/02-
Fiberglass- Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time; 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
cLA.
FIELD
'1,,^ .JsV’- 3 W.ALK. IN
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:\USERS\DATA\WP96\WP\FORMS\NY-I3.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_0 11530651
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000175984
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