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 AHERA REINSPECTION 3. Project# 14584-0819 4. Project Manager: Yiannis Efstathiou
2a. Project Address:201 Warren street, New York,NY10282 4a. Investigator:Yiannis Efstathiou
5. Date: 6. Building Name;P.S.89M 8. Turnaround Time: 9. Comments (Field):
□ STAT □ 24 HRS □ 72 HRS □ OTHER Analyzed all of them for fiberglass
7. Sampling Areas: 10. Time in / Time out:
□ 6 HRS □ 48 HOURS □ NORMAL-----
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
PS89M-4/5/02-
Fiberglass- / / Settled Dust /^loCtA^
PS89M-4/5/02-
Fiberglass-/^ Settled Dust
PS89M-4/5/02-
Fiberglass- Settled Dust
PS89M-4/5/02- —
Fiberglass- Settled Dust 7^>271>
L v c.i c In
PS89M-4/5/02-
Fiberglass- Settled Dust
PS89M-4/5/02-
Fiberglass- Settled Dust Ajl
PS89M-4/5/02-
Fiberglass- Settled Dust
PS89M-4/5/02-
Fiberglass- Settled Dust
PS89M-4/5/02-
Fiberglass- / Settled Dust
PS89M-4/5/02- Uy '
Fiberglass- Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Timec 23. Method of
Submittal:
7 7^^
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jLz|^
FIELD
WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date; 26. Time: 27. Comments (Lab):
./
24a. Analyzed By: \ A'tA'xk __ _
24b. Analyzed By; "'’r
24e. QC By:
Filename: P:\USERS\DATA\WP96\WP\FORMS\NY-I3.XLS Form NV-13
CONFIDENTIAL, CITY_21MC100_003473773
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000177690
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