NYC 9/11 Public Portal Document
Page of
ATC ASSOCIATES INC. BATCH NO. „
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1. Client: NYC - BOE 2. Project Nam AHERA REINSPECTION 3. Project# 14584-0819 4, Project Manager Yiannis Efstat'niou
2a. Project Address:201 Warren street, New York,NY10282 4a. Invcsl.igator:Mark Nakhumovich
5. Date: 6. Building Name: P.S. 89M 8. Turnaround Time; 9. Comments (Field):
i. Sampling Areas;
□ STAT □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass
10. Time in / Time out;
□ 6 HRS □ 48 HOURS □ NORMAL
SAMPLE ID MATERUL LOCATION FLOOR RESULTS
H.A.# ■NUMBER DESCRIPTION NUMBER
P.S. 89M-6/21/02-
Fiberglass- || Settled Dust
P.S. 89M-6/21/02-
Fiberglass- | 2. Settled Dust Auotf^orivnu
P.S. 89M-6/21/02-
13 Fiberglass- Settled Dust
P.S. 89M-6/21/02-
'‘f Fiberglass- ) (j Settled Dust
P.S. 89M-6/21/02-
Fiberglass- । Settled Dust
P.S. 89M-6/21/02-
P. 323
Ik, Fiberglass- J Settled Dust
P.S. 89M-6/21/02-
4^-ft HcXZvvay z<.
Fiberglass- ('y Settled Dust
P.S. 89M-6/21/02-
12niUj|
fi Fiberglass- V g Settled Dust f-Cocr /dA
P.S. 89M-6/21/02-
Fiberglass- j «| Settled Dust
P.S. 89M-6/21/02-
12. XxiM
Fiberglass- *X Settled Dust r
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
Mi WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By: X r» ^/z-rA'
24b. Analyzed By:
24c. QC By:
Filename: P:\USERS\DATA\WP96\WP\FORMS\NV-13.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_003471588
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000177213
OCR can misread numbers and units. Confirm readings against the page image before using them.