NYC 9/11 Public Portal Document
i'age 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: Yiamis Efstathiou
2a. Project Address:201 Warren street, New York,NYl 0282 4a, Investigator:Mark Nakhumovich
3. Date: 6. Building Name: P.S. 89M 8. Turnaround Time: 9. Comments (Field):
□ STAT □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass
T. Sampling Areas: 10. Time in / Time out:
□ 6 HRS 048 HOURS O NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
P.S. 89M-6/21/02-
Xi Fiberglass- 2-1 Settled Dust aja
P.S. 89M-6/21/02-
Fiberglass- JT, Settled Dust
P.S. 89M-6/21/02-
^3 Fiberglass- <2^^
P.S. 89M-6/21/02-
Settled Dust
It JUo
Alt
Fiberglass- 7. t( Settled Dust
P.S. 89M-6/21/02-
Sb" Fiberglass- 7^ Settled Dust
P.S. 89M-6/21/02-
R 3o2
cLG Fiberglass- Settled Dust
P.S. 89M-6/21/02-
ItSof
Fiberglass- Settled Dust
P.S. 89M-6/21/02-
Fiberglass- '2^ Settled Dust
P.S. 89M-6/21/02-
Fiberglass- 7,4 Settled Dust
P.S. 89M-6/21/02-
R324
Fiberglass- Settled Dust
CHAIN OF CUSTODY P ease 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
WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By: Ay' — '/u/e
24b. Analyzed By:
24c. QC By:
Filename: P.\USERS'DATA\WP96\WP\FORMS\NY-13.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_0 03471589
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000177214
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